Cardiovascular

Question 1

Order

Answer 1

Observation around bed
Appearance of patient - pain/scars/unwell
Hands and nails
Radial pulse, collapsing pulse, radio-radial delay + resp rate
Blood pressure
Face, eyes, mouth, neck
Chest - inspection, palpation, auscultation
Base of spine for oedema
Listen at base of lungs
Bruits
Feet and ankles

Question 2

Hands and nails

Answer 2

Clubbing - caused by endocarditis, cyanotic congenital heart disease, atrial myxoma (CVS), lung cancer, empyema, abscess, bronchiectasis, CF, fibrosing alveolitis (Resp)

Cap refill - should be < 3s

Tar staining

Splinter haemorrhages - infective endocarditis

Osler’s nodes and Janeway lesions - infective endocarditis

Dupuytren’s contracture - age, smoking, alcohol excess + cirrhosis, diabetes, trauma (pneumatic drill use)

Question 3

Pulse

Answer 3

Radial pulse - rate and rhythm - regular, irregularly irregular (AF), regularly irregular (heart block)
- if irregular, feel for 30s not 15s

Resp rate at same time

Collapsing pulse (aortic regurgitation) - lift arm for 30s with finger over pulse

Radio-radial and radio-femoral delay

+ Blood pressure

Question 4

Face

Answer 4

Face - pallor, malar flush (mitral stenosis)

Eyes - xanthelasmata (white lumps around eyelids, high cholesterol), corneal arcus (white ring around edge of cornea - normal sign of ageing)

Mouth - tongue for central cyanosis

Neck - carotid pulse (volume and character)
- JVP (elevated in heart failure)

Question 5

Palpation

Answer 5

Apex beat - 5th intercostal, midclavicular
(lean to left side if can’t feel)

Thrills - palpable murmur, vibration

Heaves - left ventricular hypertrophy lifting chest wall, abnormally large beat

Question 6

Auscultation

Answer 6

Aortic - 2nd IC space, right sternal edge

Pulmonary - 2nd IC space, left sternal edge

Tricuspid - 4th IC space, left sternal edge

Mitral - 5th IC space, mid-clavicular line

(S1 is tricuspid and mitral closing, systole starts, S2 is pulmonary and aortic closing, systole ends)
If hear murmur, palpate carotid at same time to see if systolic murmur

Lean onto left side, breathe out and hold, listen over apex for mitral stenosis

Sit upright, hold breath, listen over carotids for radiation of aortic stenosis

Breathe out and hold, listen over left sternal edge for aortic regurgitation

Bruits - inferior and either side to umbilicus (renal artery bruits), over femoral artery and aorta

Question 7

Feet and ankles

Answer 7

Ischaemia signs - blue, hair loss, ulcers

Venous disease - dilated veins, ulcers

Peripheral oedema - pitting or non-pitting

Palpate dorsalis pedis and posterior tibial pulses