Cardiovascular examination

Question 1

In what order should you complete the cardiovascular exam?

Answer 1

Look: Hands, face, neck, legs

Feel: Chest signs and palpitation

Auscultation

Question 2

In the cardiovascular exam, how should you first look at the patient?

Answer 2

Stand at the end of the bed and look at patient

Question 3

In the cardiovascular exam, what 7 signs should you look for when standing at the end of the bed?

Answer 3

Does patient look comfortable or uncomfortable

Pallor

Peripheral edema in limbs

Ascites in abdomen

Cyanosis

Dyspnea

Thoracic scars

Question 4

Where is a midline sternotomy scar on the chest, and what cardiovascular condition does it indicate?

Answer 4

Vertical 6-8 inches scar on middle of sternum, going down to xiphoid process

Previous coronary artery bypass graft, valve replacement or congenital heart defect correction

Question 5

Where is a mini-sternotomy scar on the chest, and what cardiovascular condition does it indicate?

Answer 5

Vertical 3-4 inches scar on middle of sternum, goes into a ‘J’ shape towards the right

Aortic valve replacement

Question 6

Where is a pacemaker scar on the chest, and what cardiovascular condition does it indicate?

Answer 6

Superiorly on left thorax in mid-clavicular line

Arrhythmias (abnormal heart beat): Sick sinus syndrome, atrial fibrillation, heart block

To prevent cardiac arrest

Question 7

Where is an anterolateral thoracotomy scar on the chest, and what cardiovascular condition does it indicate?

Answer 7

From lateral border of the sternum to the mid-axillary line at the 4th or 5th intercostal space

Lobectomy, pneumonectomy, single lung transplant, open lung biopsy

Question 8

Where is an posterolateral thoracotomy scar on the chest, and what cardiovascular condition does it indicate?

Answer 8

From mid-spinal line to the anterior axillary line

Lobectomy, pneumonectomy, single lung transplant, open lung biopsy

Question 9

Apart from on the chest, where else should you look for thoracotomy scars?

Answer 9

Around axilla for axillary scars

Question 10

What 5 signs should you look for on the dorsal surface of the hand?

Answer 10

Pallor

Tar staining

Arachnodactyly: fingers and toes are abnormally long and slender, in comparison to the palm of the hand and arch of the foot

Clubbing

Splinter haemorrhaging

Question 11

What does tar staining on the fingers indicate, in the cardiovascular exam?

Answer 11

Indicates cigarette smoking

Significant risk factor for hypertension and coronary artery disease

Question 12

What does arachnodactyly indicate, in the cardiovascular exam?

Answer 12

Indicates Marfan syndrome

Significant risk factor for aortic regurgitation

Question 13

What 3 conditions can finger clubbing indicate, in the cardiovascular exam?

Answer 13

Congenital cyanotic heart disease

Infective endocarditis

Atrial myxoma

Question 14

What signs should you look for on the palmar surface of the hand, in the cardiovascular exam?

Answer 14

Xanthomata

Janeway lesions

Osler nodes

Question 15

What is xanthomata, and what does it indicate in the cardiovascular exam?

Answer 15

Yellow lipid deposits in the skin

Indicate hypercholesterolemia, which is a risk factor of hypertension and CAD

Question 16

After looking for hand signs, what should you examine?

Answer 16

Palpate for temperature

Question 17

What do cool and dry hands indicate in the cardiovascular exam?

Answer 17

Poor peripheral perfusion

Could indicate congestive heart failure, ACS

Question 18

What do cool and clammy hands indicate in the cardiovascular exam?

Answer 18

ACS

Question 19

After palpating the hands for temperature, what should you examine?

Answer 19

Capillary refill time

Question 20

What is a normal capillary refill time, and what can CRT indicate?

Answer 20

Normal: 2 seconds

Longer that 2 seconds indicates poor perfusion

Question 22

What should be auscultated over the carotid arteries?

Answer 22

Radiation of an ejection systolic murmur caused by aortic stenosis

This is done using the diaphragm of the stethoscope while the patient holds their breath.

Question 23

Where should you auscultate for an early diastolic murmur caused by aortic regurgitation?

Answer 23

Lower left sternal border (3rd/4th intercostal space) during expiration

The patient should be sitting forwards for this assessment.

Question 24

What type of murmur is associated with mitral regurgitation?

Answer 24

Pansystolic murmur

This is auscultated over the mitral area with the patient rolled onto their left side.

Question 25

What is the position of the patient when auscultating for a mid-diastolic murmur caused by mitral stenosis?

Answer 25

On their left side ## Footnote The bell of the stethoscope is used during expiration over the mitral area.

Question 26

What is the purpose of having the patient hold their breath during carotid artery auscultation?

Answer 26

To listen for radiation of an ejection systolic murmur caused by aortic stenosis ## Footnote This technique minimizes respiratory sounds that could interfere with auscultation.

Question 27

When should the diaphragm of the stethoscope be used to listen for an early diastolic murmur?

Answer 27

During expiration ## Footnote This is specifically when auscultating over the lower left sternal border for aortic regurgitation.

Question 28

What additional area should be auscultated to identify radiation of the murmur caused by mitral regurgitation?

Answer 28

Into the axilla ## Footnote This is done while listening over the mitral area on the left side.