Cardiovascular Examination

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Cardiovascular Examination
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OBJECTIVES

• To succinctly examine the CVS system and present
  your findings to a consultant examiner in 6
  minutes
• Discuss disease processes behind your clinical
  findings
• Pass the exam.

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INTRODUCTION

• Wash your hands!!
• Introduce yourself to the patient
• Position the patient
• Explain what you are going to do
• Expose the patient adequately (roll up
  trousers/remove shirt
• Reposition patient if required

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Stand at the end of the bed STOP!! Look for a
few seconds Show you are looking around the
bed Oxygen Inhalers / GTN
Monitors/ECG Catheters / Drains Fluids /
Antibiotics Position Comfortable? Pt in pain?
Legs scars? Ulcers? Colour?
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HANDS/ARMS

• Look at both hands for
• Clubbing
• Splinter heamorrhages
• Janeway jesions
• Oslers nodes
• Cyanosis
• Nicotine staining
• tendon xanthomata
• Palpate radial pulse
• Check for a collapsing pulse
• Radio-radial delay
• Mention blood pressure

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NECK

• Carotid pulse character/voume/thrill
• JVPHeight and waveform
• Raised and pulsatile RHF
• Raised and non pulsatile SVCO
• Waveform giant systolic V waves in tricuspid
  regurgitation

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FACE

• Look at the eyes
• Conjunctival pallor
• Xanthelasma
• Corneal arcus
• Look at the Face
• Malar flush
• Conjunctival petechiae
• Dentitcian- endocarditis
• Cyanosis

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Praecordium

• Inspect
• scars median sternotomy (CABG/Valve
  replacement) Lateral thorocotomy (mitral
  valvotomy)
• Deformities
• visible pulsations

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Praecordium

• Palpate apex beat, is it displaced? Heaving?
  Tapping?
• Palpate heaves and thrills

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Praecordium

• Auscultation Mitral, tricuspid, pulmonary and
  aortic areas.
• 1. listen at apex with the bell
• 2. turn pt onto LHS and listen for mitral
  stenosis with pt in held expiration
• 3. listen at apex and into axilla (if murmur
  heard) with the diaphragm
• 4. listen in all other areas left sternal edge,
  2nd left intercostal region, 2nd right
  intercostal region
• 6. listen to carotids for bruits

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Sit the patient forward

• Listen for aortic regurgitation left sternal
  edge, held expiration.
• Listen at the lung bases for inspiratory crackles
• Feel for sacral oedema

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FINALLY

• Look at the ankles and check for pitting oedema

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THEN

• Cover the patient up
• Turn to the examiner
• I would like to complete my examination by
  measuring the blood pressure, performing an ECG
  and dipsticking the urine.
• Present your findings!!!

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FINDINGS

• The hardest part!
• Stand up straight
• Take your stethoscope and hold it in your hands
  behind your back
• Look the examiner in the eye
• No ers
• No thought I heards

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• OSCE CVS aortic stenosis
• I examined this gentlemans cardiovascular
  system.
• On general inspection he was comfortable and
  alert at rest. His face was plethoric and he had
  an oxygen mask on.
• There were no signs of infective endocarditis
  (sweating, rigors, splinter haemorrhages, janeway
  lesions, oslers nodes, tachycardia, central
  cyanosis, splenomegally) or heart failure
  (bibasal inspiratory crepitations, laterally
  displaced apex, peripheral oedema, raised jugular
  venous pulse, hepatomegally, ascites).
• The capillary refill was normal. The pulse was
  regular with a rate of 72 beats per minute.
  There was no radial-radial delay.
• There was no pallor of the conjunctiva,
  xanthelasmata or corneal arcus. There was no
  central cyanosis and dentition as good.
• The carotid pulse was slow rising. The jugular
  venous pulse was not elevated.
• On inspection of the chest there were no scars.
• On palpation the apex had a thrusting character
  and was not displaced. There were no heaves or
  thrills.
• On auscultation there was an ejection systolic
  murmur, best heard over the aortic area and
  loudest with the patient sitting forwards on
  expiration. The murmur radiated to the carotids
  and there was a soft second heart sound.

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QUESTIONS?