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Year 3 Cardiovascular Examination
Year 3 Cardiovascular Examination
History taking
1.
Chest pain
SOCRATES
2.
SOB
PND Orthopnoea
3.
Syncope / dizziness
What happened before, during, after
4.
Palpitation
Tap it out, how often and how long? Any triggers
5.
Ankle swelling
Does it get worse as the day goes on
6. 7.
HS and added HS
HS 1
HS 2
Aortic and pulmonary closure Which valve closes first the aorta or pulmonary?
HS 3
HS 4
Introduction
Inspection
General inspection
Do they look well or not Look around the bed: GTN spray
Hands
Clubbing Capillary refill Tar stains Pulse: rate, rhythm, character
Inspection 2
Hands ctd
Eyes
Radio radial delay Radio femoral delay Lift arm up collapsing pulse
Arm
Face
BP
Neck
Tongue
JVP
Palpation
Apex beat
Heaves
Thrills
Auscultate
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Auscultate 2
Diaphragm
Carotids
Sit up
Bell
In tricuspid area, listen for AR in expiration Listen to bases of lungs Look for sacral edema Look at ankles for edema
Finish
Summarise
32 year old male. O/E heart sounds 1 & 2 present with no added sounds AND no murmurs
Also like to
Feel peripheral pulses Do abdo exam looking for ascites and hepatomegaly in right heart failure Do respiratory exam looking for pleural effusion etc.
Murmurs
Type of murmur
Pan systolic Ejection systolic
Cause
Mitral / tricuspid regurgitation, VSD Aortic / pulmonary stenosis, HOCM, pregnancy Aortic/pulmonary regurgitation Mitral / tricuspid stenosis
Describing a murmur
1. 2. 3.
4.
5.
Systolic Diastolic
Which vein is it
Normal
ASK ME
JVP waveform
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Carotid
Single pulse
Cannot No effect
Respiration
Reflex Palpable pulse
No effect
No effect Palpable
SVC-O
Lowered JVP
Shock
Any questions ??