Cardiovascular clinical examination

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Author:
Anonymous
ID:
176578
Filename:
Cardiovascular clinical examination
Updated:
2012-10-09 16:46:14
Tags:
cardiovascular osce examination
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Description:
CVS clinical examination
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  1. Introduce self
    • explain examination
    • Ask for exposure from waist up.
    • Wash hands.
  2. Inspect from end of the bed
    • -awake and alert
    • -evident cyanosis
    • -breathlessness
  3. Clues around the bed
    • -GTNs and other drugs
    • -oxygen
  4. Inspect nails
    • -clubbing
    • -cholinichea (spoon shaped nails)
    • -splinter haemhorrages
    • -capillary refill
  5. Inspect hands
    • -xanthomata (biliary tract obstruction or primary biliary cirrhosis)
    • osler's nodes (infective endocarditis)
    • Jainway lesions (infective endocarditis)
    • peripheral cyanosis
  6. Inspect wrist
    • -radial pulse (take for 15s) (rate, rhythm, regularity)
    • -radioradial delay (aortic dissection)
    • -collapsing pulse (aortic regurgitation)
  7. Inspect arm
    Brachial pulse and blood pressure
  8. Inspect neck
    • JVP - use hepatojugular relfex
    • carotid pulse (one at a time)
  9. Inspect face
    • Corneal arcus (hypercholesterolemia)
    • Xanthelasma (hypercholesterolemia, unless family history exists)
    • Eyelid pallor (anaemia)
    • Mallor flush (mitral stenosis)
  10. Inspect mouth
    • Central cyanosis
    • Dentatis (infective endocarditis)
    • Arched palate (Marfan's)
    • Smoker's mouth
  11. Chest inspection
    • Scars
    • Heave
  12. Chest palpation
    • -apex beat (5th IC, mid-clavicular line)
    • -left sternal edge (heave)
    • -beneath clavical (thrill)
  13. Chest auscultation
    • -2ic RHS (mitral valve)
    • -2ic LHS (pulmonary valve)
    • -3rd LHS (aortic valve)
    • -apex beat (tricuspid valve)
  14. Accentuating maneuvres
    • -inspiration (for right heart sounds, as increases pulmonary return)
    • -expiration (for left heart sounds and carotid bruits)
    • -turn to left and listen in the axilla (mitral stenosis)
  15. Inspect ankle
    -pitting oedema (if present, check for sacral oedema)
  16. To complete examination
    • -fundoscopy
    • -ECG
    • -haematurea
    • -obs chart
    • -check lungs
    • Check abdomen for AAA, renal bruit, ascites, hepatosplenalomegaly

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