M101 Examing the Cardiovascular System Flashcards
What angle should the bed be adjusted back for a cardiovascular examination?
45 degrees
Once consent is gained to start the examination, what should you do?
ask patient to get on couch
observe for breathlessness
ask if in any pain
need help getting undressed? may need chaperone
What are the risk factors for CHD/IHD?
Arteriopathy Smoker Diabetes Clubbing infective endocarditis or SBE
What are clues from observation that the patient might have CVD?
ECGs Cigarettes cannulae GTN spray inhalers having oxygen?
What conditions can clubbing be caused by?
chronic cardiovascular conditions
congenital heart disease
respiratory conditions (lung cancer, severe pulmonary conditions)
can also be idiopathic
What are the steps for examining the hands?
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
What does nicotine staining look like?
yellow stain inside the fingers
Describe the process of finding out the capillary refill time
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
What is a symptom of SLE?
a butterfly rash / inflammation
Other signs / conditions are indicated by infective endocarditis?
Splinter haemorrhages under fingernails
Osler’s nodes
Janeway lesions
Roth spots
Describe the process of a chest inspection for CHD
Do they seem thin? Chest shape Central scar on chest from thoractomy pectus excavatum pacemaker breathing - chest motion
What can pectus excavatum affect?
heart pressure
shape of the heart
ECG findings
How do you locate a pacemaker during a chest examination?
lump on left upper chest below the clavicle and can either be an ordinary pacemaker or a defibrillator
Describe things to look for in a leg inspection for CHD
scars
oedema in legs and lower back
cellulitis
How might scars on legs be indicative of CHD?
caused by surface vein removal for use as a replacement for the coronary artery in a coronary artery bypass graft
Describe the scar left by a coronary artery bypass graft from the leg
Long thin scar going the whole way up the leg on the inside
In what order do cardiovascular examinations occur?
Inspection
Palpation
Percussion
Auscultation
Where are the three main locations for where pulses are taken?
Radial
Brachial
Carotid
What might a raised JVP indicate?
fluid overload
right ventricular failure
tricuspid regurgitation
Describe the process by which the chest is palpated
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
Which areas do you need to listen to during auscultation?
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
During auscultation, what conditions have to be met?
Has to be inspected with both faces of the stethoscope - both the bell and the diaphragm
The carotid arteries need to be gently palpated
Describe the process of auscultation
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
What can you do to accentuate any heart murmers?
roll patient on to left side at 45 degrees
listen with bell over mitral area
