Cardiovascular Examination

W I P E Wash hands Introduce yourself Position the patient: 45 Chest exposed

Inspection: around the bed and the patient:

Monitors? O2? TED stockings? Infusions? Insulin pen? Cigarettes? Etc. General impression: body habitus, distress, SOB, Syndromic features e.g. Marfans Scars: median stenotomy: CAGB, valve replacement; pacemaker Respiratory distress: breathless, increased RR, cyanosis Anaemia: finger nails, under eyelids = pallor Shock: cold, clammy, pale, tachycardia, cap refill > 2s Clubbing: congenital cyanotic heart disease, infective endocarditis, atrial myoxoma Infective endocarditis: splinter haemorrhages, Oslers nodes, Janeway lesions, poor dentition, needle marks (source of infection) Thyrotoxicosis: hot, tremor Malar flush: mitral stenosis

Palpation:
Arterial pulse: radial, carotid, measure collapsing pulse Rate (brady/tachy) 40-100 Rhythm (regular, regularly irregular, irregularly irregular) Volume (thready = shock) Character (slow rising = AS, collapsing = AR) Radial-radial/femoral delay = coarctation of aorta *Measure bp in BOTH arms for aortic dissection (examiner will stop you)* Venous pulse: JVP height and waveform (raised = fluid overload, RVF) Chest palpation: o apex beat (displaced = LVF, dilated CM) o parasternal heave: RV enlargement o thrills: palpable murmurs Diaphragm and bell at the apex Diaphragm at 4th IC space L sternal edge Diaphragm at 2nd IC space L sternal edge Diaphragm at 2nd IC space R sternal edge Bell at the apex with patient on LHS in expiration Diaphragm at 2nd IC space L sternal edge with patient sitting up in expiration Bell in the carotids

Auscultation:
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ZOHA SHAIKH JAHANZAIB KHWAJA

Heart sounds I + II Timing with carotid/radial to determine Added sounds: S3 = Ken-tucky; S4 = tenne-see Murmurs: o Timing, character, loudness, radiation, accentuation manoeuvres Lungs: LVF/CCF: basal coarse crackles auscultation = pulmonary oedema; stony dullness percussion = pleural effusion Oedema: RVF/CCF = pitting ankles, legs, sacrum

To complete:
Dipstick the urine (oedema, HTN) ECG, CXR Fundoscopy (HTN, Roths spots) Peripheral vascular examination (AAA) Palpate abdomen (hepatomegaly)

Cardiovascular Exam- Presenting the findings:

I examined Mr X, who appeared calm, comfortable and conscious and rest. There were no parephenalia suggestive of cardiovascular disease or peripheral stigmata of cardiovascular disease. The pulse was 72 beats per minutes, regular and of normal character and volume. On inspection of the chest, there were no scars. On palpation, the apex beat was not displaced and there were no heaves or thrills. On auscultation, heart sounds I and II were present with no added sounds. There was normal vesicular breathing in both lung bases and n o peripheral or sacral oedema. In summary, this is a normal cardiovascular examination I would like to dipstick the urine, examine the patients retina using fundoscopy and look at the obs chart (to measure temp, and O2 saturation).

Cardiovascular Write up
Date and Time BP: 120/80 HR: 72 bpm, regular, N volume + character HS I + II + O, JVP o Scars, o heaves o thrills, o peripheral oedema PRINT NAME
Signature (Medical Student) ZOHA SHAIKH JAHANZAIB KHWAJA

Pt. name/ D.O.B./Hospital No,

Cardiovascular System Histories

1. Introduction- own name, greeting, role, patients name and what youre going to do, consent, patients occupation. 2. PC- onset, duration, progression and description of symptoms Focussed on Cardio PC: -Chest Pain: SOCRATES -SOB - Palpitations -Leg Pain Cardio Risk Factors: Smoking IHD, stroke, PVD Diabetes HTN 3. Past medical and surgical hx: 4. Drugs hx: Remember to ask about OTC medication and recreational drugs and allergies 5. FH: Does anyone in your family suffer from similar symptoms? 6. Social history: Help at home Smoking, Alcohol Diet, Exercise Pets Foreign travel 7. Systems review: Cardiorespiratory: CP, palpitations, SOB, ankle swelling, collapse, cough, haemoptysis, wheeze, PND, orthopnoea GI: Appetite, weight loss, dysphagia, indigestion, bloating, nausea and vomiting, abdo pain, diarrhoea and constipation, change in stool Neuro: Headache, problems with vision and hearing, swallowing, pins and needles, fits, muscle weakness, sensory deficits Rheumatology: Pain/stiffness in joints/muscles/back 8. Summarise information back to patient 9. Ask about ideas, concerns, expectations (ICE)
ZOHA SHAIKH JAHANZAIB KHWAJA