Cardiovascular Exam

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Cardiovascular Exam

Patient to be undressed down to underwear

Look around the bed for ECG monitor, IV drip, medication, warfarin medication book

General inspection of patient -> SOB, mitral flush, pallor, obesity, peripheral oedema, sternotomy scars, pacemaker

Inspection of hands -> clubbing, splinter haemorrhages, tar staining cap refill, qunicke's sign, peripheral cyanosis, janeaway lesions, oslers nodes,

Feel temperature, clammy?

Examines radial pulse, rate rhythm character.

Radio-radial delay

Offer radio-femoral delay

Ask if pain in shoulder? test for collapsing pulse- feel knocking

Check for resp rate

Inspect up arms for scars

Palpate brachial pulse rate rhythm character

Offer BP

Inspect eyes for xanthelasma, anaemia, corneal arcus

Look for mallor flush

Assess mouth for central cyanosis

Look for dental hygeine

Inspection of neck -> scars of presence of central lines, de musset's sign, assess JVP

Palpate each carotid one at a time

Auscultate each carotid one at a time

Inspection of precordium -> scars, visible apex beat, visible pacemaker

Palpate precordium for heaves and thrills

Palpate apex beat, comment on its position and if it is displaced

Finger on carotid -> Auscultate 4 areas . Comment if hear murmur or normal sounds

With bell on apex, turn to patient to left side, patient holding breath from expiration, listen for mitral stenosis, also auscultate axilla

Aortic area- patient lean forward, holding breath from expiration, check for radiation of murmur to carotids

Sit patient forwards and examine back for scars

Palapate for sacral oedema

Percuss for any evidence of pulmonary oedema

Auscultate bilateral lung bases- crackles or crepitations of pulmonary oedema

Inspect legs and feet for scars

Palpate ankle oedema

Would also do peripheral vascular exam, inspect observation charts, perform fundoscopy, ECG , urine dip, Abdominal Exam, Resp exam

- Anaemia

- Infective endocarditis

- Hyperthyroidism

- Aortic regurg -> de mussets, qunickes, bounding pulse

- Co2 retention - bounding pulse

- Aortic stenosis- slow rising anacrotic pulse

- Hypertrophic cardiomyopathy jerky pulse

- Left ventricular systolic impairment pulsus alternans

- Collapsing pulse is aortic regurg

- Mitral stenosis malor flush

- Lipid disorders

- Right ventricular hypertophy heave

- Aortic stenosis systole murmur

- Aortic regurg early diastolic

- Pulmonary stenosis- harsh ejection systolic murmur

- Mitral regurg- pan systolic murmur