cardio exam Flashcards
(30 cards)
At what angle should the patient’s head be positioned for the cardio exam?
45 degrees
Before you do anything else in the cardio exam, what three things should you do?
Wash your hands
Tell the patient who you are and obtain consent
Examine the praecordium and general appearance
Why is the head positioned upwards for the cardio exam?
To allow the JVP (jugular venous pressure) to be assessed
What is the first step of the cardio exam proper?
Examination of the hands
How are the hands correctly examined in the cardio exam?
First looking at the nails (clubbing) and finger ends
Then looking at palmar creases etc
What is examined after the hands in the cardio exam?
The radial pulse
What should be noted about the radial pulse in the cardio exam?
Rate of pulse
Rhythm
Presence or absence of delay of the femoral pulse compared with the radial pulse
Is the volume and character of the pulse best felt at the radial artery or the brachial artery?
Brachial
What should be measured after the radial pulse in the cardio exam?
Blood pressure
Where is the best place for the bladder of the blood pressure cuff to be placed?
The antecubital fossa on the medial arm
Is it important if the bladder of the blood pressure cuff is not at the level of the heart?
Yes – will add to or subtract from the blood pressure reading if it isn’t on the level of the heart
If the bladder of the blood pressure cuff is lower than the heart, would you expect that to add to the actual blood pressure or subtract from it?
Add to it
Reading will be higher if the cuff is lower
What is the name of the sounds that you can hear in your stethoscope while listening during blood pressure measurement?
Korotkoff sounds
How many korotkoff sounds are there?
5
What is the austultatory gap?
When the korotkoff sounds disappear just under the systolic pressure and reappear before the diastolic pressure
After the blood pressure and radial pulse are assessed, what is the next step in the cardio exam?
Examination of the face
How do you examine the face in the cardio exam?
Look at the sclera (jaundice)
Into the mouth at the palate (Marfan if it’s high), teeth (IE), ask the patient to stick the tongue out and look at lips for central cyanosis
After the face, what is examined in the cardio exam?
The neck
How is the neck examined in the cardio exam?
Palpate the carotid arteries
JVP height should be assessed
What is examined after the neck in the cardio exam?
The praecordium
Must the praecordium be inspected before commencing with its examination in the cardio exam?
Yes – looking for things such as scars, pectus excavitatum (Marfans; also, deformity of the chest can change the places where you expect to find heart sounds), pace-maker
Also look for the apex beat but if you can’t see it then you will palpate for it
How is the praecordium palpated in the cardio examination?
Apex beat at 5th intercostal, 1cm medial to midclavicular line
Parasternal impulse at the left of the sternum with the finger lifted slightly off the chest (right ventricular enlargement if present)
Thrills can be felt with the palm of the hand starting left sternum, moving laterally across the base of the heart (superior). Apical thrills felt with patient rolled on to left side, basal thrills felt best with patient sitting up leaning forward in full expiration
Should the chest be listened to (auscultation) or tapped (percussed) first?
Percussion and then auscultation
How should the praecordium be percussed?
Midclavicular line moving inferiorly to find base of heart, then anterior axillary line towards sternum in 5th intercostal space to find the left border
