W01L02 Examination of the Cardiovascular System Flashcards
Cardiovascular Examination
Introduction Inspection Palpation Percussion Auscultation
Peripheral cyanosis
Darkish blue caused by peripheral vasoconstriction, can be due to heart failure, shock, cold temperature or abnormalities of circulation. E.g Raynaud’s disease
Usually present on extremities (peripheral cyanosis) or mucous membranes e.g. under tongue, around mouth (central cyanosis)
Tar staining
Sign of smoking
Nail clubbing
Interphalangeal depth ratio is increased
10% endocarditis
Splinter haemorrhage
Frequently due to trauma or endocarditis
Koilonychia
Spoon shaped nails
Degeneration commonly caused by iron deficiency anaemia, or trauma or petroleum solvents
Oslers nodes
Little raised red tender nodules on the tops of the fingers and toes
Painless, uncommon sign of endocarditis
Janeway lesions
Micro abscess
Signs of endocarditis
Central cyanosis
Visible under the tongue
Always present with peripheral cyanosis
Due to abnormal circulation
Malar flush
Results of low cardiac output (types of cyanosis around the cheeks)
Mitral valve stenosis
Conjunctivae
Pallor of conjunctivae visible in patients with low haemoglobin due to anaemia
Xanthelasma
Cholesterol-rich fatty deposits which occurs around tendons
Little bundles of lipid containing macrophages around the eye
Check cholesterol and lipid levels in patients (50%)
Corneal Arcus
Little white ring around cornea
Lipid degeneration
Check patient cholesterol level
Sternotomy Scar
Sign of thoracic surgery
Palpation (radial vs carotid)
Easier to tell character on carotid
Collapsing pulse
A pulse that rises very very quickly and calls away quickly
Feel for vibrations of pulse through the forearm
Aortic valve regurgitation
Aortic valve is leaky and cannot prevent backflow into left ventricle, therefore pulse falls away quickly
The excess volume then causes the next pulse to be very strong
Apex beat
Mid clavicular line 5th intercostal space
Left ventricular hypertrophy can cause displacement of apex beat
Parasternal heave
Hand will be pushed off the chest wall by the contraction of the right ventricle
Thrills
Palpable murmur (sternal notch, etc) Murmur caused by turbulence of blood through abnormal valves
Congestive heart failure
Blood not cleared properly due to right heart failure
Symptoms: swollen internal jugular vein and swollen liver
How to check jugular venous pulse
Patient lies at 45 degrees, turns to one side
Measure the horizontal distance across and vertical distance down to the sternal angle (normal if less than 4cm)
3 rules of auscultation
- Distinguish 1st and 2nd heart sounds
- Listen for the heart sounds where they are the loudest
- Use bell and diaphrahm
Heart sounds (1st and 2nd)
First heart sound is the closing of the mitral/tricuspid valves
Second sound is the closing of the semilunar valves
Ejection click
Stiff valves trying to open up
Pansystolic murmur
Mitral regurgitation causes constant leakage of blood all during systole
Early aortic diastolic murmur
Aortic valve cannot close properly, therefore backflow into the left ventricle, occurs during diastole
Pulmonary and aortic auscultation are on…
Opposite sides of anatomical region due to direction of blood flow
Auscultate lung bases for…
Crepitations (crackles)
Cardiac failure
a complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation
Right sided heart failure most often secondary to…
Left sided failure
Symptoms of cardiac failure
Exertional dyspnoea
Othopnoea
PND
Fatigue
Signs of cardiac failure
Tachycardia/pnoea Hypotension Pulmonary oedema Pleural effusion Elevated JVP Peripheral oedema Ascities Tender hepatomagaly
