Cardiac Examination Flashcards
(33 cards)
Roughly outline the sections of a cardiac exam?
1.Introduction
2. End of bed
3. Hands
4. Nails
5. Wrists
6. Arm
7. Face
8. Eyes
9. Mouth
10 Neck
11. Chest inspection
12. Palpation
What are you looking for on general inspection?
Clinical signs
Objects equipment
What clinical signs are you looking for?
Cyanosis SOB Pallor Malar flush Oedema
What is malar flush?
Plum red discolouration of cheeks associated with mitral stenosis
What does pallor indicate?
Underlying anaemia - haemorrhage
Poor perfusion - congestive heart failure
What objects and equipment might be relevant?
Pillows = congestive heart failing resulting in inability to lie flat
Vital signs
Fluid balance
Prescriptions GTN
What would you look at in the hands?
Feel temperature and check CRT Peripheral cyanosis Tendon xanthalasma Osler nodes and janeaway lesions Tar staining Arachnodactyly
What are you expecting with the colour and temperature of the hands?
Warm and well perfused or peripherally shut down = CRT >2s
Cyanosis may indicate PVD, Raynauds, CCR
What does tendon xanthalasma indicate?
Hypercholesterolaemia
What do roth spots and Janeaway lesions indicate?
IE
What is arachnodactyly?
Abnormally long fingers and toes
A feature of Marfan’s syndrome which is associated with mitral/aortic valve prolapse and aortic dissection
What would you look for in the nails?
Finger clubbing - IE, CHD, atrial myxoma
Koilonychia - iron def anaemia
Splinter haemorrages - IE, trauma
What would you look for in the wrist?
Radial pulse and brachial pulse
+ Rate
+ Rhythm
+ Volume
+ Character
Collapsing pulse
+ “Is your shoulder sore at all?”
+ Grasp pt tight wrist with your right hand
+ Place your metacarpal heads over pt radial artery
+ Quickly but gently left their arm about their head and palpate for collapsing pulse
Assess for radio radio delay (cervical rib, aortic coartication/dissection, embolism) and radio femoral delay (coarticatoins/dissection, embolism)
What would you assess in the arm?
I would now measure blood pressure in each arm
Wide pp (more than 100) AR Narrow pp (less than 25) AS
What are the types of pulse character?
Normal
Slow rising - aortic stenosis
Bounding - aortic regurgitation and CO2 retention
Thready - Intravasc hypovolaemia
What are the thresholds for hyper and hypotension?
Hyper > 150/90
Hypo <90/60
What would you asses for in the face?
Malar flush - mitral stenosis
What would you assess for in the eyes?
Corneal arcus and xanthalasma - hypercholesterolaemia
Conjunctival pallor
What would you assess for around the mouth?
Central cyanosis - lung disease, cardiac shunt, abnormal Hb
Poor dentition - RF for IE
High arches palate - Marfans - M/A prolapse and aortic diss
What would you assess for in the neck?
Carotid pulse -
Exaggerated (Corrigans sign) - AR
AUSCULATE BEFORE PALPATING for bruits
Palate for pulse character
JVP
Describe how you would assess JVP and HJRT?
Pt at 45 degrees, head turned slightly to the right, neck well lit (not too much)
Look for double pulsation on the left side of neck
Estimate height above sternal angle in cm (3-4)
“Do you have a sore stomach at all”
Push on RUQ and watch neck to see JVP rise
Check JVP rapidly falls back down - persistent elevation indictese RHF/volume overload
What are you looking for when inspecting the chest?
Scars
+ Pacemaker / ICD under either clavicle
+ Midline sternotomy - CABG, valve replacement
+ Left submammary - mitral valvotomy, pericardial window
+ Legs - vein harvesting
Visible heave - apical (LVH) or parasternal (RVH)
What do you palpate in the chest?
Apex beat
+ Locate and count rib spaces
+ Assess character
+ 5ic mid clavicular line
Left parasternal heave - RVH
Thrills - palpable murmur
What do you auscultate in the chest?
4 Primary valve areas Apex - mitral (B,D) LLSE - tricuspid (D) 2nd left IC space - pulmonary (D) 2nd right IC space - aortic (D)
Areas of murmur radiation
Axilla - MR (D)
Carotid (B) - hold breath with patient
Manoeuvres to amplify
- Apex pt on LHS, breath held in expiration = MS
- LLSE, pt sitting forward breath held in expiration = AR
