CVS Exam

Question 1

Observation

Answer 1

o Shortness of breath
o Cyanosis
o Pallor (pale appearance)
o Oedema (+ ankles)
o Inspect hands- splinter haemorrhages (infective endocarditis), peripheral cyanosis (congenital heart failure)
o Capillary refill- squeeze nails, should take no more than 3s to refill
o Bring two fingers together- Schamroth’s window test- not present with clubbing
o Inspect eyes- pull lower eye lid down (anaemia)
o Chest deformities or scars

Question 2

Auscultation

Answer 2

o Carotids- ask Pt to hold their breath
o Each valve
1. Mitral- fifth intervertebral space in mid-clavicular line
2. Tricuspid- fourth intercostal, lower sternal edge
3. Pulmonary- second intercostal space, left sternal edge
4. Aortic- second intercostal space, left sternal edge

Question 3

Palpation

Answer 3

o Radial pulse
o Brachial pulse
o Jugular venous pressure- Pt at 45 deg, localised between two heads of SCM
o Palpate apex beat- 5th intercostal space, left sternal edge
o Assess sacral oedema (congestive heart failure- important to consider if they have been led down for prolonged period)

Question 4

Blood pressure exam

Answer 4

Gain consent
Rest arm on table
Ensure appreciate size
Attach
Estimate systolic- palpate radial, inflate cuff until no radial pulse
Note reading when it disappears
Palpate brachial artery
Place stethoscope over
Reinflate 20-30 above
Slowly diffuse
Korotkoff sound- sound heard when blood begins to pass through artery after obstruction has been removed, when cuff is deflated
When pulse disappears note it
Release cuff

Question 5

Normal

Answer 5

Lub dub
S1 S2 are the same

Question 6

Mitral stenosis

Answer 6

Strong S1 weak S2

Question 7

Mitral regurgitation

Answer 7

Hear BF between S1 and S2
Murmur

Question 8

Aortic stenosis

Answer 8

S1 inc, S2 inc