Clinical Examinations - Cardiology Flashcards
What should you do before performing any clinical examination. (6)
Introduce yourself. Obtain Consent. Confirm Name and Age of patient. Wash Hands. Expose Patient. Ensure Patient is Comfortable.
What should you do before touching the patient.
Inspect from the end of the bed.
When you are inspecting the patient, what are you looking for.
Signs of distress.
Paraphernalia indicative of disease (eg, inhalers, oxygen, IV lines, etc…).
What should you observe for in the face particularly in a cardiovascular examination.
Malar flush.
What should you look for in the hands in a cardiovascular examination. (5)
Clubbing. Cyanosis - are their hands warm? Stigmata of endocarditis. Nicotine Stains. Capillary refill time.
What are the stigmata of endocarditis visible in the hands. (3)
Janeway lesions.
Splinter haemorrhages.
Osler’s nodes.
How do you take the pulse at the radial artery. (4)
- You compress the radial artery with your index finger and middle fingers.
- Note whether the pulse is regular or irregular.
- Count the pulse for 15-30seconds and multiple for 1 minute.
- You should count the pulse for a full minute if the pulse is irregular.
What do you look for at the radial pulse. (3)
Rate.
Rhythm.
Collapsing pulse (Waterhammer pulse).
How do you check for a collapsing pulse.
You raise the patient’s arm.
How would you check a patient’s blood pressure. (8)
- Position the patient’s arm so that the anticubital fossa is level with the heart.
- Centre the bladder of the cuff over the brachial artery approximately 2cm above the anticubital fold (make sure that you use the proper cuff size)
- Palpate the radial pulse and inflate the cuff until the pulse disappears. (this is the approximate systolic pressure).
- Place the stethoscope over the brachial artery.
- Inflate the cuff to 30mmHg above the estimated systolic pressure.
- Release the pressure slowly, about 5mmHg per second.
- The level at which you consistently hear beats is the systolic pressure.
- Deflate the cuff until the sounds muffle and disappear. This is the diastolic BP.
What are you looking for in the tongue in a CV exam. (2)
Pallor.
Cyanosis.
How do you check for anaemia.
Anaemia is detected via conjunctiva pallor.
How do you take the carotid pulse.
Place your fingers behind the patient’s neck and compress the carotid artery with your thumb at or below the level of the cricoid cartilage.
What is the physical landmark for taking a carotid pulse.
Cricoid cartilage.
What should you be careful about doing when taking the carotid pulse.
Do not compress on both sides of the neck at the same time - it will be very uncomfortable for the patient, and can cut off the blood supply to the brain and cause syncope.
What can compressing the carotid sinus in the neck cause. (2)
Bradycardia.
Depressed BP.
What do you assess at the carotid pulse.
Character (eg is it slow rising?).
How do you assess for carotid bruits. (3)
- Place the bell of the stethoscope over each carotid artery.
- Ask the patient to stop breathing for a moment.
- Listen for a blowing or rushing sound.
Who should you listen for carotid bruits in. (2)
Middle aged.
Elderly.
What is a carotid bruit often a sign of. (2)
A sign of arterial narrowing.
Increased risk of stroke.
How do you examine a patient’s JVP. (3)
- Position the patient supine with the head of the table at 45 degrees.
- Look for a rapid, double (sometimes triple) wave with each heartbeat.
- Assess the height of the pulsation from the sternal angle.
When do you consider that the JVP is raised.
If it is more than 4cm from the sternal angle.
How do you distinguish between the JVP and carotid pulse.
If you press lightly, you will eliminate the venous pulsation.
A arterial pulse does not collapse under pressure.
In what position do you observe for precordial movement.
Ideally supine.
