Cardiovascular examination Flashcards
Consent and examination
Examination requires removal of clothes from waist up except the bra, which can be loosened or removed at the time of heart valve auscultation
Bed position
45 degrees
General inspection
Respiration: rate
Colour: cyanosis, anaemia
Items around: cigarettes, GTN spray, monitors, oxygen
Hands
Temperature
Clubbing
Stigmata of endocarditis
Peripheral cyanosis
Tar staining
Xanthoma
Capillary refill
Radial pulse
Rate: normal 60-90
Rhythm: quickens during inspiration (normal), irregular could be af, or ectopic
Arms
Pulse waveform in brachial artery
Blood pressure
Venepuncture sites
Face
Anaemia
Corneal arcus
Xanthelasma
Dental hygiene
Central cyanosis
Neck
Carotid pulse: timing and rhythm
JVP: hepatojugular reflex
Chest inspection
Scars
Pacemaker/ implantable defibrillator
Visible pulsation
Chest palpation
Apex beat: palpate laterally if needed, cardiomegaly
Heaves: left sternal edge
Thrills: palpable murmur
Chest auscultation
Mitral area
Tricuspid area
Pulmonary area
Aortic area
Prosthetic valves
Basal crepitations (evidence of heart failure)
Stethoscope
Using diaphragm in all areas
Use bell additionally in apex for low frequency murmur (mitral stenosis)
Murmurs
Site: mitral incompetence best heard with diaphragm, mitral stenosis with bell
Timing: palpate carotid pulse
Radiation: mitral murmur roll onto left side and listen to left axilla, aortic murmur sit forward 2nd ICS left sternal edge
Added sounds
S3: can be heard in healthy individuals especially children and in pregnancy
S4
Opening snap
Pericardial friction rub: evidence of pericardial effusion
Peripheral oedema
Sacrum: press for 5 sec over sacrum
Feet/ ankles/ legs: press for 5 secs over bony prominences
