M101 Examing the Cardiovascular System

Question 1

What angle should the bed be adjusted back for a cardiovascular examination?

Answer 1

45 degrees

Question 2

Once consent is gained to start the examination, what should you do?

Answer 2

ask patient to get on couch
observe for breathlessness
ask if in any pain
need help getting undressed? may need chaperone

Question 3

What are the risk factors for CHD/IHD?

Answer 3

Arteriopathy 
Smoker 
Diabetes
Clubbing
infective endocarditis or SBE

Question 4

What are clues from observation that the patient might have CVD?

Answer 4

ECGs
Cigarettes
cannulae
GTN spray
inhalers
having oxygen?

Question 5

What conditions can clubbing be caused by?

Answer 5

chronic cardiovascular conditions
congenital heart disease
respiratory conditions (lung cancer, severe pulmonary conditions)

can also be idiopathic

Question 6

What are the steps for examining the hands?

Answer 6

colour - cyanosis suggests hypoxia
temperature - cool peripheries may suggest poor cardiac output / hypovolaemia
Sweaty or clammy
Nicotine staining (smoker)
Capillary refill time should be less than 2 seconds

Question 7

What does nicotine staining look like?

Answer 7

yellow stain inside the fingers

Question 8

Describe the process of finding out the capillary refill time

Answer 8

press for five seconds over the nail bed or over the sternum

Within two seconds, the colour that has temporarily gone from that section of skin will bounce back

Question 9

What is a symptom of SLE?

Answer 9

a butterfly rash / inflammation

Question 10

Other signs / conditions are indicated by infective endocarditis?

Answer 10

Splinter haemorrhages under fingernails
Osler’s nodes
Janeway lesions
Roth spots

Question 11

Describe the process of a chest inspection for CHD

Answer 11

Do they seem thin?
Chest shape
Central scar on chest from thoractomy
pectus excavatum
pacemaker
breathing - chest motion

Question 12

What can pectus excavatum affect?

Answer 12

heart pressure
shape of the heart
ECG findings

Question 13

How do you locate a pacemaker during a chest examination?

Answer 13

lump on left upper chest below the clavicle and can either be an ordinary pacemaker or a defibrillator

Question 14

Describe things to look for in a leg inspection for CHD

Answer 14

scars
oedema in legs and lower back
cellulitis

Question 15

How might scars on legs be indicative of CHD?

Answer 15

caused by surface vein removal for use as a replacement for the coronary artery in a coronary artery bypass graft

Question 16

Describe the scar left by a coronary artery bypass graft from the leg

Answer 16

Long thin scar going the whole way up the leg on the inside

Question 17

In what order do cardiovascular examinations occur?

Answer 17

Inspection
Palpation
Percussion
Auscultation

Question 18

Where are the three main locations for where pulses are taken?

Answer 18

Radial
Brachial
Carotid

Question 19

What might a raised JVP indicate?

Answer 19

fluid overload
right ventricular failure
tricuspid regurgitation

Question 20

Describe the process by which the chest is palpated

Answer 20

put heel of hand parallel to the left sternal edge
feeling for an englarged heart - find apex beat
normal apex beat is around the 5th intercostal space.
Enlarged heart will be around the 6th

Question 21

Which areas do you need to listen to during auscultation?

Answer 21

aortic area - 2nd intercostal space, right of the sternal angle
pulmonary area - 2nd intercostal space, left of the sternal angle
tricuspid area - 4th/5th intercostal space, lower left of the sternal angle
mitral area - 5th intercostal space, mid clavicular line

Question 22

During auscultation, what conditions have to be met?

Answer 22

Has to be inspected with both faces of the stethoscope - both the bell and the diaphragm
The carotid arteries need to be gently palpated

Question 23

Describe the process of auscultation

Answer 23

Listen to all four areas with the diaphragm then with the bell
Time S1 by gently palpaltating the right carotid
Patient should sit forward, breathe in, breathe out, then hold breath
Listen to heart sounds in aortic area with them in expiration

Question 24

What can you do to accentuate any heart murmers?

Answer 24

roll patient on to left side at 45 degrees

listen with bell over mitral area

Question 25

Which three additional areas should you listen at and for what during auscultation?

Answer 25

Neck - listen for radiation of murders
Posterior chest - crackles and fluid on the base of the lungs - risk of heart failure
Abdomen - listen for aortic bruises

Question 26

What other tests will you do towards the end of the cardiovascular examination?

Answer 26

peripheral vascular examination
record a 12-lead ECG
Dipstick urine
Test blood glucose
Fundoscopy