An example of a perfect cardiovascular examination for OSCE/ISCEs for medical students, or in clinical practice for junior doctors. Step-by-step guide covering an examination from hands-neck-face-chest, including signs, symptoms and their relevance in forming a clinical differential diagnosis. Cove...
Cardiovascular - Any bruising, scars, petechiae (red/purple raised
spots) – sign of meningitis
Examination Neck
1. Wash hands - Carotid pulse; rate, rhythm, strength, bruit?
2. Introduce o Examine both but not together
3. Explain and gain consent - JVP – patient at 45degrees, look to left, relax!
4. Correct position – 45degrees o Normal <4cm above sternal angle
5. Exposure – waist up, remove bra ideally
Face/mouth/eyes
General inspection:
- Pallor; anaemia in conjunctiva
Surroundings: - Xanthelasma – cholesterol deposits around eye
- Walking aids - Corneal arcus – cholesterol deposit, blue ring
- Cigarettes - Central cyanosis – under tongue
- Medication – GTN spray (angina spray, bright - Dentition – poor teeth = endocarditis
red with white cap) o Bacteria translocation
- Bedside monitoring
Patient-based:
- Patient in pain? Chest inspection
- Breathless?
- Closer inspection for scars
- Cyanotic?
- Pacemaker?
- On oxygen?
- Visible apex beat
- Shape of chest
- Scars?
o Thoracotomy
Palpation
o Central sternotomy
o Pacemaker - Feel for apex beat
o Coronary bypass graft - Heaves – sign ventricular hypertrophy
- Bruising – from blood thinners - Thrills – palpable murmur
o Move hand vertical and horizonal
snaking up chest
Hands
- Clubbing – infective endocarditis, carcinoma
Auscultation
(atrial myxoma), congenital heart disease
- Peripheral cyanosis - Aortic, pulmonary, tricuspid, mitral valves
- Cool peripheries – good perfusion o Any additional sounds
- Cigarette tar stains o Aortic = louder when sit forward,
- Splinter haemorrhages – sign of endocarditis breathe in, out + hold
o Small dark lines in nails o Mitral = louder = roll to left
- Xanthomata – cholesterol deposits in tendons of - Listen to lung bases for pulmonary
hands congestion(oedema)
- Examine for sacral/pedal oedema
o Right heart failure
Wrists/arm
- Pulse – both sides; rate, rhythm, character
o Test for delay on one side – aortic
coaction; faster = narrowing
- Collapsing pulse – raise pulse and see if it
changes, would hit hand harder
- Blood pressure
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller PassMedSchool. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £3.49. You're not tied to anything after your purchase.