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Cardiovascular Examination

From Mediwikis

Wash Hands

Slick run through of cardio exam by OSCE PASS. For more free OSCE guides check out: http://www.oscepass.com

Introduction, Explanation, Consent

  • Exposure
  • Ask about pain
  • Patient positioned lying 45 degrees

General Inspection

  • Generally well
  • Breathlessness
  • Cyanosis
  • Scars
  • Assess respiratory rate for 30 seconds

Hands

  • Tar stains
  • Peripheral cyanosis
  • Splinter haemorrhages
  • Clubbing (congenital heart disease, bacterial endocarditis)
  • Osler's nodes
  • Janeway lesions
  • Capillary refill

Pulse

  • Radial pulse
    • Heart rate (15 seconds x4)
    • Rate
    • Regularity
    • Character
    • Raise patient's arm above head - collapsing pulse
  • Radial-radial delay
  • "Radial-femoral delay"
  • Carotid
    • Slow-rising character
  • If hypovoloemia or peripheral vascular disease suspected, check further pulse points.

Blood pressure

  • Feel for the pulse as you inflate cuff, note the pressure at which it disappears
  • Inflate the cuff above the pressure noted whilst listening to the brachial artery
  • Initially you will hear no sound (no blood flow)
  • Then you should hear the blood flow (turbulent flow) and note the pressure at which this becomes apparent
  • Finally the sounds will disappear (turbulent flow)

Record the systolic and diastolic pressures.

Neck

  • Raised JVP - upon hepatojugular reflux
  • Tracheal deviation (mediastinal shift)

Eyes

  • Anaemia
  • Jaundice
  • Corneal arcus
  • Xanthelasma

Mouth

  • Central cyanosis (colour of tongue and lips - if dusky blue/purple = cyanosis)
  • Dental hygiene (infective endocarditis)
  1. Tongue is normal size and color.
  2. No angular stomatits or mouth ulcers

Chest

Inspection

  • Scars
  • Precordial pulsations
  • Visible cardiac heaves

Palpation

  • Apex beat - 5th intercostal space, midclavicular line
  • Heaves (palpable prechordial impulses - feels like the heart is coming up to punch your hand) - palm horizontal, heel over left sternal edge
  • Thrills (palpable murmurs ie mitral stenosis - feels like a cat purring) - palm vertical on both sides of sternum

Auscultation

  • Heart sounds - while palpating carotid pulse - pulse coincides with 1st heart sound
    • Aortic - 2nd intercostal space, right of sternum
    • Pulmonary - 2nd intercostal space, left of sternum
    • Tricuspid - 5th intercostal space, left of midline
    • Bicuspid - 5th intercostal space, midclavicular
  • 1st and 2nd heart sound findings
    • Added sounds
    • Intensity
    • Splitting
    • Murmurs
  • Auscultate neck for carotid bruit (turbulent flow, suggesting stenosis)
  • Auscultate axilla for further radiation.

Back

Inspection

  • Scars

Palpation

  • Sacral oedema

Auscultation

  • Lung bases - crackles (pulmonary oedema)

Legs

  • Pedal pitting oedema

Wash Hands

Summary

  • Heart Rate
  • Heart sound 1+2 present, no additional sounds
  • No signs of peripheral vascular disease.#