Cardiovascular Examination - PowerPoint PPT Presentation

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Cardiovascular Examination

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... present your findings to a consultant examiner in 6 minutes ... The pulse was regular with a rate of 72 beats per minute. There was no radial-radial delay. ... – PowerPoint PPT presentation

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Title: Cardiovascular Examination


1
Cardiovascular Examination
2
OBJECTIVES
  • To succinctly examine the CVS system and present
    your findings to a consultant examiner in 6
    minutes
  • Discuss disease processes behind your clinical
    findings
  • Pass the exam.

3
INTRODUCTION
  • Wash your hands!!
  • Introduce yourself to the patient
  • Position the patient
  • Explain what you are going to do
  • Expose the patient adequately (roll up
    trousers/remove shirt
  • Reposition patient if required

4
Stand at the end of the bed STOP!! Look for a
few seconds Show you are looking around the
bed Oxygen Inhalers / GTN
Monitors/ECG Catheters / Drains Fluids /
Antibiotics Position Comfortable? Pt in pain?
Legs scars? Ulcers? Colour?
5
HANDS/ARMS
  • Look at both hands for
  • Clubbing
  • Splinter heamorrhages
  • Janeway jesions
  • Oslers nodes
  • Cyanosis
  • Nicotine staining
  • tendon xanthomata
  • Palpate radial pulse
  • Check for a collapsing pulse
  • Radio-radial delay
  • Mention blood pressure

6
NECK
  • Carotid pulse character/voume/thrill
  • JVPHeight and waveform
  • Raised and pulsatile RHF
  • Raised and non pulsatile SVCO
  • Waveform giant systolic V waves in tricuspid
    regurgitation

7
FACE
  • Look at the eyes
  • Conjunctival pallor
  • Xanthelasma
  • Corneal arcus
  • Look at the Face
  • Malar flush
  • Conjunctival petechiae
  • Dentitcian- endocarditis
  • Cyanosis

8
Praecordium
  • Inspect
  • scars median sternotomy (CABG/Valve
    replacement) Lateral thorocotomy (mitral
    valvotomy)
  • Deformities
  • visible pulsations

9
Praecordium
  • Palpate apex beat, is it displaced? Heaving?
    Tapping?
  • Palpate heaves and thrills

10
Praecordium
  • Auscultation Mitral, tricuspid, pulmonary and
    aortic areas.
  • 1. listen at apex with the bell
  • 2. turn pt onto LHS and listen for mitral
    stenosis with pt in held expiration
  • 3. listen at apex and into axilla (if murmur
    heard) with the diaphragm
  • 4. listen in all other areas left sternal edge,
    2nd left intercostal region, 2nd right
    intercostal region
  • 6. listen to carotids for bruits

11
Sit the patient forward
  • Listen for aortic regurgitation left sternal
    edge, held expiration.
  • Listen at the lung bases for inspiratory crackles
  • Feel for sacral oedema

12
FINALLY
  • Look at the ankles and check for pitting oedema

13
THEN
  • Cover the patient up
  • Turn to the examiner
  • I would like to complete my examination by
    measuring the blood pressure, performing an ECG
    and dipsticking the urine.
  • Present your findings!!!

14
FINDINGS
  • The hardest part!
  • Stand up straight
  • Take your stethoscope and hold it in your hands
    behind your back
  • Look the examiner in the eye
  • No ers
  • No thought I heards

15
  • OSCE CVS aortic stenosis
  • I examined this gentlemans cardiovascular
    system.
  • On general inspection he was comfortable and
    alert at rest. His face was plethoric and he had
    an oxygen mask on.
  • There were no signs of infective endocarditis
    (sweating, rigors, splinter haemorrhages, janeway
    lesions, oslers nodes, tachycardia, central
    cyanosis, splenomegally) or heart failure
    (bibasal inspiratory crepitations, laterally
    displaced apex, peripheral oedema, raised jugular
    venous pulse, hepatomegally, ascites).
  • The capillary refill was normal. The pulse was
    regular with a rate of 72 beats per minute.
    There was no radial-radial delay.
  • There was no pallor of the conjunctiva,
    xanthelasmata or corneal arcus. There was no
    central cyanosis and dentition as good.
  • The carotid pulse was slow rising. The jugular
    venous pulse was not elevated.
  • On inspection of the chest there were no scars.
  • On palpation the apex had a thrusting character
    and was not displaced. There were no heaves or
    thrills.
  • On auscultation there was an ejection systolic
    murmur, best heard over the aortic area and
    loudest with the patient sitting forwards on
    expiration. The murmur radiated to the carotids
    and there was a soft second heart sound.

16
QUESTIONS?
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