Dept of Internal Medicine

Cardiovascular examination

From Talley and O’Connor 6th Edition

Sem 4 GKV

Dr Scarpa Schoeman

0823787333 or schoemanfhs@ufs.ac.za

Dept of Internal Medicine

UFS

Dept of Internal Medicine

Overview

• Prep for the examination sessions PLEASE

• Talley and O’Connor - ! Yes please ! – DVD and text.

• MUST understand cardiac cycle.

• There are variations in practice – (it will confuse you

probably)

• PLEASE ASK QUESTIONS!!!!!!

Dept of Internal Medicine

Overview

Taken from:Evans, D. E., & Brown, J. (2009). How to succeed at medical school : an essential guide to learning (p. ix, 179 p.). Oxford: Wiley-Blackwell.

Evans-Brown Model to learn clinical skills

Dept of Internal Medicine

Overview

Basic Science

StepsClinical

Reasoning

Michels, M. E. J., Evans, D. E., & Blok, G. A. (2012). What is a clinical skill? Searching for order in chaos through a modified Delphi process.

Sem 1-5 Anatomy + Physiology

p102 (TC 6th edition)Sem 5+ = Experience!!

Dept of Internal Medicine

Cardio exam• INTRODUCTION (name and role)

• INFORMED CONSENT

• Ask pt to undress & CLEAN HANDS (you)

• Inspection

• Palpation

• Percussion

• Auscultation

• Thank pt and help to get dressed

Dept of Internal Medicine

Cardio exam• From the bedside (Insp)

• Level of illness – acute, chronic, acute on chronic

• Additional stuff - O2, tubes!• Chest wall – scars, deformities, lumps, pulsations

• Hands & Wrists (Insp) • Clubbing• Cyanosis (peripheral) • Splinter bleeds, Osler nodes, Janeway lesions(IE) • Tar staining (smoking)• Palmar erythema (red palms)

Dept of Internal Medicine

Cardio exam• Hands & Wrists (Palp)

• Cap refill (<2sec), temp of hands, • PULSES

• Rate (30 sec: REGULAR pulse, 1min IRREGULAR)

• Rhythm (AF!!)• Character and Volume (bigger artery)

• Hyperdynamic? Weak?• Rad/Rad & Rad/Fem delay (coarctation)

• Arms – BLOOD PRESSURE (p54-55)

Dept of Internal Medicine

Cardio exam• FACE

• Eyes• Anaemia + Jaundice• Arctus cornealis/senilis• Xanthelasma

• Cheeks redness (?mitral facies) • Mouth

• Lips – peripheral cyanosis• Tongue – central cyanosis• Bad teeth – site for bacteraemia• High arch palate (Marfan’s)

Dept of Internal Medicine

Cardio exam• NECK

• Carotid arteries palp (and Auscultation)• JVP (SUPER NB)

• Indication of RA pressure• 45° position is NB• Distance from RA to sternal angle(SA) = 5cm• Then vertical height above SA to max pulsation• POSITION yourself in top spot!

Dept of Internal Medicine

Cardio exam• Precordium

• Palpation• Z-manoeuvre (thrills and heaves)• APEX BEAT!!! • Percussion – not very useful at all

• Auscultate• M , T , P, A , Carotid (?stenosis)• Diaphragm (+bell for M)

• Manoeuvres• Left lateral – MS• Sitting forward - AI

Dept of Internal Medicine

Cardio exam• BACK

• Inspect: scars, deformities, lumps• Palpation

• Sacral oedema• Auscultate

• Breath sounds (? Different L vs R)• Fine basal creps = Pulm oedema (LHF)• Absent – percuss for pleural effusion

• ABDOMEN• Hepatomegaly? (Pulsatile liver – TI)• Splenomegaly?• Ascites?• Aorta aneurism• Fem arteries (palp and Ausc)

Dept of Internal Medicine

Cardio exam• LEGS

• Pulses present?• Toes (same as hand – not tar staining!)• DVT?• Ankle oedema (pitting 1-3+)

• Other• Fundoscopy• Urine dipstix• Temp (fever)

Dept of Internal Medicine

Overview

Basic Science

StepsClinical

Reasoning

Michels, M. E. J., Evans, D. E., & Blok, G. A. (2012). What is a clinical skill? Searching for order in chaos through a modified Delphi process.

p102 (TC 6th edition)

Dept of Internal Medicine

Overview

Taken from:Evans, D. E., & Brown, J. (2009). How to succeed at medical school : an essential guide to learning (p. ix, 179 p.). Oxford: Wiley-Blackwell.

Evans-Brown Model to learn clinical skills

Dept of Internal Medicine

Cardio exam

Many thanks!!!