Introduction
Introduce yourself Explain what you would like to examine Gain consent Place patient at 45° with chest exposed Ask if patient has any pain anywhere before you begin!General Inspection
Bedside for treatments or adjuncts – GTN spray, O2, Tablets, Wheelchair, Warfarin Comfortable at rest? SOB Malar Flush Chest for scars & visible pulsations Legs for harvest site scars and peripheral oedema ..Hands
Temperature - poor peripheral vasculature Capillary refill – should be <2 seconds Colour – cyanosis Clubbing Splinter haemorrhages, Jane-way lesions, Oslers Nodes – infective endocarditis Palmar Erythema – hyperthyroidism, pregnancy, polycythaemia Nicotine Staining – smokerPulses
Radial Pulse – rate & rhythm Radial-Radial Delay – aortic coarctation Collapsing Pulse – aortic regurgitation BP – narrow pulse pressure = Aortic Stenosis | wide pulse pressure = Aortic Regurgitation Carotid – character & volume JVP – measure and also possibly carry out hepatojugular reflexFace
Eyes – conjunctival pallor, jaundice, corneal arcus, xanthelasma Mouth – central cyanosis, angular stomatitis Dental hygiene – infective endocarditisClose Inspection Of Chest
Scars - lateral thoracotomy (mitral valve), midline sternotomy (CABG), clavicular (pacemaker) Apex beat – visible in aortic regurgitation and thyrotoxicosis Chest wall deformities – pectus excavatum, pectus carniatumPalpation
Apex beat – 5th intercostal space, mid clavicular Heaves- left sternal edge – seen in left & right ventricular hypertrophy Thrills – Palpatable murmurs over aortic valve & apexAuscultation
Listen over 4 valves - ensure palpation of carotid pulse to determine first heart sound Roll onto left side & listen in mitral area – mitral stenosis Lean forward & listen over aortic area- aortic regurgitation Carotids - radiation of aortic stenosis murmurs & bruits Lung bases – pulmonary oedema Sacral Oedema & Pedal OedemaTo complete the examination
Thank Patient Wash hands Summarise Findings Say you wouldAssess peripheral pulses Carry out an ECG Dipstick urine Bedside Blood Glucose Fundoscopy source :
- Macleod
- http://geekymedics.com/osce/cardiovascular-examination-2/
