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Cardiovascular history

& examination

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History taking1. 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. Any claudication?

7. Risk factors1. Smoke2. DM3. High BP4. Cholesterol5. Diet / exercise6. FH

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HS and added HS

HS 1 Mitral and tricuspid closure When would it be loud?

MS, tachycardia, short PR interval, tachycardia

When would it be soft MR, PR long

HS 2 Aortic and pulmonary closure Which valve closes first – the aorta or pulmonary?

Aorta –

this is called splitting of second heart sound HS 3

Rapid ventricular filling Dilated LV (cardiomyoptahy, post MI, MR)

HS 4 Atrial contracting against a stiffened ventricle

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Introduction

WASH HANDS

Introduce

Consent Expose

Offer them a blanket

45 degrees Are you in any pain?

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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

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Inspection 2

Hands ctd

Radio radial delay

Radio femoral delay

Lift arm upcollapsing pulse

Arm

BP

Neck

JVP

Eyes

Anaemia

Xanthalasma

Corneal arcus Fundoscopy

Face

Malar flush

Tongue

Dental hygiene

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Palpation

Apex beat

5th ICS – MCL

Heaves RVH

Thrills

Palpable murmur

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Auscultate

 www.kumc.edu

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Auscultate 2

Diaphragm Mitral Tricuspid Pulmonary Aorta

Carotids radiation of aortic stenosis

Bell Aortic Pulmonary Tricuspid Mitral

Left lateral position Listen with the bell in mitral

area in expiration

Listen in axilla with bell for

radiation of mitral regurgmurmur

Sit up In tricuspid area, listen for

AR in expiration Listen to bases of lungs Look for sacral edema Look at ankles for edema

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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 andhepatomegaly in right heart failure

Do respiratory exam – looking for pleuraleffusion etc.

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Murmurs

Type of murmur Cause

Pan systolic Mitral / tricuspid

regurgitation, VSDEjection systolic Aortic / pulmonary

stenosis, HOCM,pregnancy

Early diastolic Aortic/pulmonaryregurgitation

Mid diastolic Mitral / tricuspid stenosis

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Describing a murmur

1. Position heard loudest

2. Pitch

3. Radiation4. Intensity (grade 1-6)

5. Timing

1. Systolic2. Diastolic

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Jugular venous pressure

Which vein is it

Internal jugular vein

Why are we examining it

Gives us an indication of RA pressure

Normal

<4cm from angle of louis

What happens in inspiration to the JVP? Waveform

ASK ME

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JVP waveform

 www.clinicalexam.com

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Differences: JVP and carotid

JVP CarotidCharacter Double

pulsationSingle pulse

Obliteration Can beobliterated Cannot

Position JVP falls if situp

No effect

Respiration JVP falls No effect

Reflex Hepatojugular No effect

Palpable pulse No Palpable

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Increased or decreased JVP

Raised JVP with no waveform

SVC-O

Raised JVP with normal waveform

RHF

Fluid overload

Lowered JVP

Shock

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Thank you for listening

Any questions ??

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