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
Examination
May present with:
Chest pain, SOB, leg swelling, palpitations, claudication, light- Neck
headedness, collapse
- Carotid pulse; rate, rhythm, strength, bruit?
W.I.P.E.E o Examine both but not together
- 45 degrees lying down o Listen for bruit with stethoscope
- Exposure = waist up, ideally no bra - JVP – patient at 45degrees, look to left, relax!
o Normal <4cm above sternal angle
General inspection:
- Walking aids
- Cigarettes Face/mouth/eyes
- Medication – GTN spray (angina spray, bright red - Pallor – anaemia in conjunctiva
with white cap)
- Xanthelasma – cholesterol deposits around eye
- Bedside monitoring
- Corneal arcus – cholesterol deposit, blue ring
- Patient in pain?
- Central cyanosis – under tongue
- Breathless? - Dentition – poor teeth = sign of endocarditis
o Due to bacteria translocation
- Cyanotic?
- On oxygen?
- Shape of chest
- Scars? Chest inspection
o Thoracotomy
o Central sternotomy - Closer inspection for scars (listed earlier)
o Pacemaker - Pacemaker?
o Coronary bypass graft - saphenous - Visible apex beat – 5th intercostal space, midclavicular line
- Bruising – from blood thinners
Palpation
Hands
- Feel for apex beat
- Clubbing – infective endocarditis, carcinoma (atrial - Heaves – sign ventricular hypertrophy
myxoma), congenital heart disease - Thrills – palpable murmur
- Peripheral cyanosis o Move hand vertical and horizonal snaking up chest
o May be able to feel vibrations of aortic stenosis
- Cool peripheries – good perfusion
- Cigarette tar stains – on nails
- Splinter haemorrhages – sign of endocarditis
oSmall dark lines in nails
Auscultation
- Xanthomata – cholesterol deposits in tendons of - Aortic, pulmonary, tricuspid, mitral (apex) valves
hands o Any additional sounds?
o Aortic = louder when sit forward, breathe in, out
+ hold
o Mitral = louder when roll to LHS
Wrists/arm
- Lung bases – listen for pulmonary congestion(oedema)
- Radial pulse – both sides; rate, rhythm, character
o Test for delay on one side – aortic coaction; - Examine for sacral/pedal oedema
faster side = side with narrowing o Sign of right heart failure
- Collapsing pulse – raise pulse and see if it changes,
would hit hand harder against your fingers
- Blood pressure Further examinations:
- Any bruising, scars, petechiae (red/purple raised - Full medical history
spots) – sign of meningitis - Peripheral vascular examination
- Perform an ECG
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