Cardiovascular Examination

Question 1

In a cardiovascular exam, what hand signs are you looking for?

Answer 1

Xanthomata, finger clubbing, osler nodes (digits), janeway lesions (palm), tar staining, pale palmar creases, capillary reflill, splinter haemorrhages

Question 2

What is a xanthomata and what does it indicate?

Answer 2

Cholesterol-rich deposits along tendons

Associated with hyperlipidaemia which is a risk factor for cardiovascular disease

Question 3

What heart defects is Marfan’s syndrome associated with?

Answer 3

Mitral/aortic valve prolapse and

aortic dissection

Question 4

In a cardiovascular examination, what can finger clubbing be a sign of?

Answer 4

Congenital cyanotic heart disease

(sub acute) Infective endocarditis

Atrial myxoma

Question 5

What signs in the hand are associated with infective endocarditis?

Answer 5

Splinter haemorrages, Janeyway lesions (palm), and Osler nodes (digits)

Question 6

In a cardiovascular examination what initial observations might you look for?

Answer 6

Cyanosis, shortness of breath, pallor, malar flush, oedema

Question 7

What is a malar flush associated with?

Answer 7

Mitral stenosis

Question 8

In a cardiovascular examination, what can cool sweaty/clammy hands be a sign of?

Answer 8

Acute coronary syndrome

Question 9

What can prolonged capillary refill be a sign of?

Answer 9

Hypovolemia, congestive heart failure

Question 10

What checks should be done in the pulse part of a cardiovascular examination?

Answer 10

Radial pulse (rate, rhythm, character), radio-radial delay, radio-femoral delay, collapsing pulse, brachial pulse, carotid pulse, blood pressure

Question 11

Name some causes of radio-radial delay

Answer 11

Subclavian artery stenosis, aortic dissection, aortic coarctation

Question 12

Name some causes of collapsing pulse

Answer 12

Normal physiological states -Fever/pregnancy

Cardiac - aortic regurgitation, patent ductus arteriosus

High output states - anaemia, hyperthyroidism, arteriovenous fistula

Question 13

What can a thready pulse be a sign of?

Answer 13

Hypovolaemia/sepsis

Question 14

What can a bounding pulse be a sign of?

Answer 14

CO2 retention/aortic regurgitation

Question 15

What can a slow rising pulse be a sign of?

Answer 15

Aortic stenosis

Question 16

A narrow pulse is less than 25 mmHg between systolic and diastolic. What can cause this?

Answer 16

Aortic stenosis, congestive heart failure, cardiac tamponade

i.e. problems with pumping

Question 17

A wide pulse is more than 100 mmHg between systolic and diastolic. What can cause this?

Answer 17

Aortic regurgitation and aortic dissection

i.e. problems with blood pooling

Question 18

What can blood pressure difference between each arm indicate?

Answer 18

Aortic dissection

Question 19

What does the presence of a bruit in the carotid artery suggest?

Answer 19

Carotid stenosis

Question 20

In a cardiovascular examination what order do you 1. palpate the carotids 2. auscultate the carotids and why

Answer 20

Auscultate first to listen for bruits, important because palpating may dislodge causing ischaemic stroke

Question 21

What are cardiac causes of a raised JVP?

Answer 21

Right-sided heart failure

Pulmonary hypertension (raised pressure in pulmonary arteries due to COPD/lung disesase)

Tricuspid regurgitation (due to infective endocarditis/rheumatic heart disease)

Question 22

What eye signs are relevant to the cardiovascular system examination?

Answer 22

Conjunctival pallor

Corneal arcus

Xanthelasma

Kayset-Fleischer rings (Wilsons disease from abnormal copper processing)

Question 23

What mouth signs are relevant to the cardiovascular system examination?

Answer 23

Central cyanosis from lips/tongue, angular chelitis, high arched palate, poor dental hygiene

Question 24

What could the presence of a median sternotomy scar indicate?

Answer 24

Cardiac valve replacement

or

Coronary artery bypass graft (CABG)

Question 25

What could an anterolateral thoracotomy scar indicate?

Answer 25

Minimall invasive cardiac valve surgery

Question 26

What could an infraclavicular scar indicate?

Answer 26

Pacemaker insertion

Question 27

What could a mid-axillary scar indicate?

Answer 27

Insertion of subcutaneous implantable cardioverter-defibrillator (ICD)

Question 28

In a cardiovascular examination, what order should you do chest palpation?

Answer 28

Apex beat –> heaves –> thrills

Question 29

What might a displaced apex beat indicate?

Answer 29

Ventricular hypertrophy

Question 30

What might a parasternal heave indicate?

Answer 30

Right ventricular hypertrophy

Question 31

Describe the order of auscultation manoeuvres and what each is listening for

Answer 31

1. Auscultate carotid arteries whilst pt holds breath –> aortic stenosis
2. Auscultated aortic valve during expiration –> aortic regurgitation
3. Roll pt to left side and listen to mitral area during expiration –> mitral regurgitation
4. Same but with bell –> mitral stenosis