WEEK 14 OSPAP Programme Cardiovascular Examination Kate Brown

WEEK 14 OSPAP Programme Cardiovascular Examination Kate Brown Slide 1 of 24 MPHM 14 OSPAP Respiratory

WEEK Principles of Cardiovascular examination 14 • Includes: ØGeneral inspection ØSpecific inspection (hands, face, chest) ØPalpation ØAuscultation ØPulses & ankle oedema Slide 2 of 24 MPHM 14 OSPAP Respiratory

WEEK 14 Slide 3 of 24 MPHM 14 OSPAP Respiratory

WEEK Inspection 14 • • • General inspection Hands Face Eyes Mouth Anterior chest Slide 4 of 24 MPHM 14 OSPAP Respiratory

WEEK General inspection 14 • General health of the patient • Obvious pain • Colour- cyanosis/pallor • Measurements: – – – Slide 5 of 24 BP Resps Temp Sp. O 2 ECG MPHM 14 OSPAP Respiratory • Obvious abnormalities – Marfan syndrome(dissecting aneurysm of ascending aorta, incompetent mitral valve) – Down’s syndrome – (congenital heart defect, VSD) – Turner’s syndrome(coarctation of the aorta, left sided heart defects)

WEEK Hands 14 • Temperature (infection/perfusion) • Clubbing (infective endocarditis/chronic disease) • Splinter haemorrhages (infective endocarditis) • Capillary refill (perfusion) • Pale palmar creases • Tar staining Slide 6 of 24 MPHM 14 OSPAP Respiratory

WEEK Pulses 14 • • • Radial pulses (both/compare) for rate rhythm Brachial pulses for volume and character Carotids (not together) Dorsalis pedal and posterior tibial (ankle oedema at this point or during palpation) Slide 7 of 24 MPHM 14 OSPAP Respiratory

WEEK Face 14 • • • Pale conjunctiva (anaemia) Jaundice Xanthelasma Corneal arcus Tongue for central cyanosis Mouth and teeth for infection (infective endocarditis) Slide 8 of 24 MPHM 14 OSPAP Respiratory

WEEK Inspection 14 JVP • Right atrial pressure • Patient positioned 45 degrees • Turn head laterally • Visualise any pulsations • Measure maximum height from sternal notch Slide 9 of 24 MPHM 14 OSPAP Respiratory

WEEK Inspection 14 Internal Jugular Vein Slide 10 of 24 MPHM 14 OSPAP Respiratory

WEEK Inspection 14 Raised JVP indicative of: • Heart Failure • SVC obstruction • Increased blood volume (pregnancy, acute nephritis, excess fluid therapy) If JVP rises on inspiration consider: • Pericarditis • Cardiac tamponade Slide 11 of 24 MPHM 14 OSPAP Respiratory

WEEK Inspection 14 Inspection of Chest: • Deformity • Masses • Scars • Bruising • Visible heaves or pulsations Slide 12 of 24 MPHM 14 OSPAP Respiratory

WEEK 14 Palpation • Apex beat • Heaves • Thrills • Peripheral pulses • Ankle oedema Slide 13 of 24 MPHM 14 OSPAP Respiratory

WEEK Palpation 14 Position of Apex beat: • Place hand across chest, feel with fingers for the lateral edge of pulsating apex (5 th intercostal space mid clavicular line) • If not palpable turn patient onto left side and palpate anterior axillary line Slide 14 of 24 MPHM 14 OSPAP Respiratory

WEEK 14 Cardiac Surface Anatomy Recap Slide 15 of 24 MPHM 14 OSPAP Respiratory

WEEK 14 Prominent apex beat Palpation LVH Medially displaced apex beat Lung collapse, lung fibrosis Laterally displaced apex beat LVH, pleural effusion, pneumothorax Downward displaced apex beat Volume overload, mitral/aortic incompetence Sustained apex beat forceful but not displaced Pressure overload, aortic stenosis, hypertension, LVH Failed detection of apex beat Obesity, hyperinflation, Parasternal heave pulsation at left base of sternum Right ventricular hypertrophy Tapping apex beat, palpable first heart sound Mitral stenosis Palpable second heart sound Systemic or pulmonary hypertension Thrills Palpable murmurs Systolic thrill in aortic area Aortic stenosis Systolic thrill at apex Mitral regurgitation Diastolic thrill Mitral stenosis Slide 16 of 24 MPHM 14 OSPAP Respiratory

WEEK 14 Auscultation • • Heart sounds S 1 - closure of mitral and tricuspid valves S 2 - closure of aortic and pulmonic valves S 3 & S 4 Splitting Murmurs Base of lungs Diaphragm & Bell Slide 17 of 24 MPHM 14 OSPAP Respiratory

WEEK Auscultation 14 • Lower pitched sounds Diaphragm • Higher pitched sounds • S 3 & S 4 • Mitral stenosis • S 1 & S 2 • Systolic murmurs Bell Slide 18 of 24 MPHM 14 OSPAP Respiratory

WEEK Auscultation 14 A P T Slide 19 of 24 MPHM 14 OSPAP Respiratory M

Auscultation WEEK 14 A P T Slide 20 of 24 MPHM 14 OSPAP Respiratory M

WEEK 14 Slide 21 of 24 Cardiac Murmur Radiation MPHM 14 OSPAP Respiratory

WEEK Normal Heart Sounds 14 • Normal S 1 and S 2 Sounds Slide 22 of 24 MPHM 14 OSPAP Respiratory

WEEK Recap 14 Examination: Ø General inspection Ø Specific inspection (hands, face, chest) Ø JVP Ø Palpation Ø Auscultation Ø Pulses Ø Ankle oedema Slide 23 of 24 MPHM 14 OSPAP Respiratory History: Ø Presenting Complain Ø Hx PC (OPQRSTU) Ø Prev Med Hx Ø Drug Hx Ø Family Hx Ø Social Hx Ø Systems Review

WEEK Practice 14 • Take turns in your threes to perform a cardiac examination Slide 24 of 24 MPHM 14 OSPAP Respiratory