Cardiovascular Examination

Question 1

Introduction

Answer 1

Wash Hands
ID yourself and patient
Explanation
Consent
Pain/Tenderness
Positioning
Exposure

Question 2

General Assessment

Answer 2

General Observations, Environment, Charts

Question 3

Peripheral Examination

Answer 3

Hands+Arms: Tar Staining, Warmth of Hands, Peripheral Cyanosis or Anaemia, Clubbing, Splinter Haemorrhages, Capillary Refill, Fine Tremor
Radial Pulse: Rate, Rhythm, Volume, Character
IV Drug Use

Face - Malar Flush
Conjunctivae: Pallor/Anaemia, Xanthalasmata/Corneal Arcus
Tongue+Lips: Central Cyanosis
Angular Stomatitis, Sore Red Tongue

Chest: Lung bases for crackles - Left sided HF
Sacral Oedema

Lower Limbs: Pitting Oedema, Arterial Disease (ischaemia), Varicose Veins

Question 4

Assessment of JVP

Answer 4

45 Degree position, head tilted to left

Double Venous Flickering

Question 5

Examination of the Precordium

Answer 5

Inspection: Kyphoscoliosis, Pectus Excavatum, Scars, Cardiac Pacemaker

Palpation: Tracheal Position, Pacemaker, Apex Beat, Heaves (Left of Sternum), Thrills (Apex + Both Sides of Sternum)

Auscultation:

1. All 4 Valve Areas (diaphragm + bell) palpate carotid. Listen to Heart Sounds, Added Sounds, Murmurs
2. Radiation of Left Sided Systolic Murmurs. Aortic Stenosis: Aortic Valve area + over both carotids. Mitral Regurgitation: Apex and Left Axilla.
3. Left Sided Diastolic Murmurs: Mitral Stenosis: Roll onto left side, listen at apex, breath out and hold with bell. Aortic Regurgitation: Lean forward, hold breath in expiration. Lower sternal edge with diaphragm

Question 6

Peripheral Pulses

Answer 6

VOLUME and COMPARE SIDES
Radial
Brachial
Carotid
Femoral (radial femoral delay)
Popliteal
Posterior Tibial
Dorsalis Pedis
BRUITS: Carotid and Femoral

Question 7

Closure

Answer 7

Thank Patient
Tell them you’re done
Wash hands