Cardiovascular examination

Question 1

What position should the patient be in for a cardiovascular exam?

Answer 1

45 degree angle on couch

Question 2

What should you look for in general inspection in a cardiovascular exam?

Answer 2

Medications on the side, devices, cigarettes, catheters, GTN spray, oxygen, IV fluids, number of pillows

Question 3

What should you look for when inspecting the patient in a cardiovascular exam?

Answer 3

Shortness of breath/resp rate, oedema, cyanosis, pallor, malar flush, syndromic features, scars, ECG stickers/leads

Question 4

What does a lot of pillows suggest?

Answer 4

Heart failure

Question 5

How will a patient be laid if they have pulmonary oedema?

Answer 5

Upright as if they were flat the fluid in their lungs would make it hard to breathe

Question 6

What syndromes are associated with cardiovascular disease?

Answer 6

Marfan’s, Down’s

Question 7

What is malar flush and what does it indicate?

Answer 7

A red flush across the cheeks and face, associated with mitral stenosis, occurs because there is backflow in the heart which causes CO2 retention

Question 8

What syndrome has a widened neck as a feature?

Answer 8

Turner’s syndrome

Question 9

What cardiovascular problem is common in those with Turner’s syndrome?

Answer 9

Coarctation of the aorta and a biscuspid aortic valve (should be tricuspid)

Question 10

What does clubbing indicate?

Answer 10

Low blood oxygen

Question 11

What does tar staining indicate?

Answer 11

Smoking

Question 12

What does peripheral cyanosis in the hands indicate?

Answer 12

Reduced cardiac output (especially in hyperkalemia), Brainiard’s disease

Question 13

What does xanthoma look like?

Answer 13

Yellow skin or tender nodules with lipid deposition on the palmar and extensor surfaces of the hand

Question 14

What does xanthoma indicate?

Answer 14

High cholesterol

Question 15

What are some visible signs associated with infective endocarditis?

Answer 15

Clubbing
Poor dentition
Splinter haemorrhages

Question 16

What do splinter haemorrhages look like?

Answer 16

Small brown lines on the nails

Question 17

What to janeway lesions look like?

Answer 17

Small lesions on the palms

Question 18

What are janeway lesions associated with?

Answer 18

Infective endocarditis

Question 19

What do osler’s nodes look like and where are they found?

Answer 19

Small painful nodes on the ends of fingers and toes

Question 20

What do osler’s nodes indicate?

Answer 20

Infective endocaridits

Question 21

Why do Osler’s nodes occur?

Answer 21

Deposition of immune complexes

Question 22

In a cardiovascular exam when inspecting the hands what should you look for on the nails?

Answer 22

Clubbing
Splinter haemorrhages
Quincke’s sign
Tar staining

Question 23

What should you inspect for when looking at hands in a cardio exam?

Answer 23

Nails
Cap refil time
Temperature
Peripheral cyanosis
Xanthoma
Osler's nodes
Janeway lesions
Arachnodactyly

Question 24

What is Quincke’s sign and why does it occur?

Answer 24

Pulsation of the nail bed associated with aortic regurgitation

Question 25

How do you test cap refil time? What is the normal response?

Answer 25

Squeeze the distal end of a patients fingers for 5 seconds and release the colour should return in less than 2 seconds

Question 26

What may hot and sweaty hands indicate in a cardiological exam?

Answer 26

MI, fever

Question 27

What might cold hands suggest in a cardiological exam?

Answer 27

Poor perfusion

Question 28

What is arachnodactyly and why is it relevant in a cardiological exam?

Answer 28

It is a feature of Marfan's syndrome where fingers are long, it helps identify marfan's patients who may be at risk of mitral or atrial regurgitation

Question 29

What are the 3 things you do in a cardiological exam when taking pulse?

Answer 29

``` Radial pulse (rate and rhythmn) Radio-radial delay Radio-femoral delay ```

Question 30

How many bpm is classified as bradycardic?

Answer 30

< 60 bpm

Question 31

What may cause bradycardia?

Answer 31

Being on beta blockers Normal in younger people and athletes Hypothyroidism

Question 32

How many bpm is classified as tachycardic?

Answer 32

> 100 bpm

Question 33

What may cause tachycardia?

Answer 33

Fever, pain, stress, hyperthyroidism, exercise, hypovolemia

Question 34

If a heart beat is irregular what are the two ways it can be so?

Answer 34

Irregularly irregular ie completely spontaneous | Regularly irregular ie there is a pattern

Question 35

What is an irregularly irregular heart rate associated with?

Answer 35

Atrial fibrillation

Question 36

What is a regularly irregular heart rate associated with?

Answer 36

Heart block | Ectopic beats

Question 37

What are ectopic beats?

Answer 37

When a heart beat is missed

Question 38

How do you test for radial radial delay?

Answer 38

Feel the radial pulse on both arms and they should be synchronised

Question 39

What may cause a radial radial delay?

Answer 39

Aortic dissection, subclavian artery stenosis or aortic cooptation

Question 40

What do you assess when feeling the brachial pulse?

Answer 40

Character and volume

Question 41

What characters may a brachial pulse be?

Answer 41

Slow rising or bounding

Question 42

What would a slow rising brachial pulse indicate?

Answer 42

Aortic stenosis

Question 43

What would a bounding brachial pulse suggest?

Answer 43

Carbon dioxide retention or aortic regurgitation

Question 44

What pulses are felt for in a cardiological exam?

Answer 44

Radial, brachial

Question 45

What would thready volume when taking a brachial pulse indicate?

Answer 45

Hypovolemia

Question 46

How do you assess for collapsing pulse?

Answer 46

Take the radial pulse (and brachial pulse simultaneously) and lift their arm up briskly and you may feel their pulse collapse

Question 47

What is collapsing pulse typical of?

Answer 47

Aortic regurgitation

Question 48

What must you ask the patient before assessing for collapsing pulse?

Answer 48

If their shoulder is in any pain as you will have to quickly lift their arm

Question 49

What blood pressure constitutes hypertension?

Answer 49

Greater than or equal to 140/90

Question 50

What blood pressure constitutes hypotension?

Answer 50

Less than or equal to 90/60

Question 51

Why do we check blood pressure in both arms?

Answer 51

If there is a difference of more than 20 mmHg between the 2 it could indicate aortic dissection or atherosclerosis

Question 52

What is pulse pressure?

Answer 52

The difference between the systolic and diastolic blood pressure

Question 53

What constitutes narrow pulse pressure?

Answer 53

<25mmHg difference

Question 54

What constitutes wide pulse pressure?

Answer 54

>100mmHg difference

Question 55

What could narrow pulse pressure indicate?

Answer 55

Aortic stenosis or congestive heart failure

Question 56

What could wide pulse pressure indicate?

Answer 56

Aortic regurgitation or aortic dissection

Question 57

What is conjunctival pallor and what does it indicate in terms of cardiology?

Answer 57

Lack of colour when the eye is pulled down (anterior conjunctiva) indicates anaemia which is a risk factor for heart disease

Question 58

What is coarctation of the aorta?

Answer 58

A birth defect where part of the aorta is narrower than it should be

Question 59

What is Quincke's sign?

Answer 59

Systolic pulsations after the nail bed is slightly compressed