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
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