Cardiovascular Assessment

 

Emergency

 

Hx

Ex

Ix

Mx

 

Index

 

 

  

 

Cardiovascular History

 

HPI

PMH

 

Social

 

Family

 

 

  

Cardiovascular History of Presenting Illness (HPI)

 

-  Chest pain: AMI, angina

-  Dyspnoea: cor pulmonale, CCF

-  PND: CCF

-  Orthopnea (# pillows): CCF

-  Syncope: cardiogenic shock (AMI), vasovagal, carotid body hypersensitivity

-  Palpitations: AMI, AF, VT, VF, SVT

-  Fatigue: cardiac failure

-  Calf/leg pain: DVT, intermittent claudication (PVD)

          

 

 

  

Cardiovascular Past Medical History (PMH)

 

-  DM + BSL, hyperlipidaemia, HTN

-  BMI, Metabolic syndrome

-  Vascular Sx: CABG, Carotid Endarterectomy

-  PPM, AICD

-  AMI/CAD/stroke/PVD, AF

-  Rheumatic fever: mitral stenosis

          

 

 

  

Cardiovascular Social & Personal History

 

-  Smoking: atherosclerosis, stroke

-  EtOH: cardiomyopathy

-  IVDU: IE

-  BMI: Metabolic syndrome

-  Diet, exercise

-  Turners syndrome: coarctation

-  Marfans syndrome: aortic regurgitation

 

 

 

  

Cardiovascular Family History

 

-  DM, HTN, hyperlipidaemia

-  AMI/CAD/stroke/PVD

-  Sudden deaths: arythmias (VT, Torsades, VF), HCM

 

 

 

 

Cardiovascular Examination

 

General

 

Head

 

Arm

 

Chest

Abdo

Leg

 

 

 

  

General Cardiovascular Examination

 

-  Sweating: AMI, vasovagal

-  Pallor: AMI, anaemia

-  Dyspnoea: APO

-  Cachexia: cardiac failure

 

 

 

  

Cardiovascular Upper Limb Exam

 

-  Nicotine (tar) staining: smoking

-  Pulse: pulsus paradoxus

-  Janeway lesions, Oslers nodes & splinter haemorrhages: IE

-  Cyanosis: heart failure, congenital heart disease

-  Clubbing: congenital heart disease, IE

-  Pale palmar creases & capillary refill: anaemia

-  Tendon xanthomata: hyperchol 2 (hyperlipidaemia)

 

Tendon Xanthomata

 

-  Palmar xanthomata: hyperchol 3 (hyperlipidaemia)

-  Radial pulse

-  Rate: normal 60-100bpm

-  < 60: bradycardia

-  > 100: tachycardia

-  Rhythm: regularly regular or arythmias (VT..)

-  Irregularly irregular: AF

-  Collapsing: aortic regurgitation

-  Pulsus alternans: left heart failure

-  Radio-radial delay: obstruction, aortic dissection

-  Radio-femoral delay: coarctation

-  BP

-  Postural Drop: hypovolaemia

-  Hypertension/Hypotension

-  Unequal bilaterally: co-arctation of aorta

 

 

 

  

Cardiovascular Head & Neck Exam

 

-  Pale conjunctiva: anaemia

-  Xanthelasma, corneal arcus: hyperchol (hyperlipidaemia)

 

xanthelasma

 

Corneal Arcus

 

-  Icterus: CCF (hepatic congestion)

-  Cyanosis

-  Central: tongue

-  Peripheral: lips

-  High arched pallete: Marfans syndrome

-  Mitral facies/flush: mitral stenosis

-  Dentition: IE

 

Neck

-  JVP

-  Elevated (> 4 cm): R heart failure, volume overload, pericardial disease

-  Becks Triad

-  Elevated JVP, hypotension, muffled heart sounds: cardiac tamponade

-  Measured w pt at 45o from sternal angle

-  Difficult to see: Hepatojugular Reflux

-  Kaussmals Sign

-  Elevation of JVP with inspiration

-  Indicates R heart dysfunction

-  Carotid pulse

-  Character

-  Anacrotic & plateau: aortic stenosis

-  Bisferiens: aortic stenosis & regurgitation

-  Collapsing: aortic regurg, hyperdynamic circulation, PDA, athersclerotic aorta, arteriovenous fistula

-  Alternans: L heart failure

-  Volume: small (aortic stenosis, pericardial effusion)

-   Bruit: atherosclerosis, aortic regurgitation

 

 

 

  

Cardiovascular Chest Exam

 

Sequence of Cardio Chest Exam 

-  Anterior Chest

-  Inspect

-   PPM, AICD

-   Scars: thoracotomy, sternotomy..

-  Apex beat (PMI): cardiomegaly

-  Pectus excavatum/carinatum: Marfans syndrome

-  Palpate: apex beat: thrill, heave

-  Percuss (rare): Cardiomegaly: HTN

-  Auscultate

-   Valves: pulmonary, aortic, tricuspid mitral

-   Muffled: obesity, cardiac tamponade (Becks triad)

-   Murmurs: regurg, stenosis

-  Systolic/Diastolic: DDx w pulse

-  Carotid a.: aortic stenosis

-  Aortic murmur wo carotid rad.: aortic sclerosis (common in elderly)

-  Axilla: MR

-  Grade 1-6

-   Extra sounds: S3, S4

-  Dynamic Manouvres:

-   Roll into L lateral position: mitral stenosis

-   Lean forward w held expiration: aortic regurg, pericardial friction rub

 

Heart Valves

 

9380

 

-  Posterior chest

-  Inspect: sacral oedema: R heart failure

-   Look for signs of heart failure (fluid)

-  Palpate: sacral oedema

-  Percuss: Intercostal dullness: pulmonary oedema from L heart failure

-  Auscultate: Lung creps: L heart failure

 

 

 

  

Cardiovascular Abdominal Exam

 

-  For full exam see Abdo Exam

-  Hepatosplenomegaly: R heart failure

-  Splenomegaly: IE

-  Hepatojugular Reflux

-  (Abdominojugular reflux)

-  Firm pressure on liver for 10-60 seconds

-  Elevation of JVP > 4 cm: elevation

-  Normal: elevation 1-2 heart beats only

-  Abdominal aorta palpable/visible: AAA

-  Abdominal mass

-  Pulsatile abdomen & epigastric bruit: renal a. stenosis

-  Pulsatile liver: tricuspid regurg

 

 

 

  

Cardiovascular Lower Limb Exam

   

-  Pedal oedema: R heart failure

-  Pulses: DVT, PVD

 

Lower Limb Peripheral Pulses

 

-  Bruit: PVD

-  Buergers Test: PVD

-  Pt supine, elevate both legsto 45o for 2 minutes

-  Observe color of feet

-  Indicates ischaemia if pallor develops

-  Sit pt up and hand legs at 90o over edge of bed

-  Positive for ishceamia if skin becomes blue frist then red

-  Veins: varicose, ulcers

-  Haemosidriosis, lipodermatosclerosis (gaiter area): venous insufficiency

 

Lipo & Haemo

 

 

 

 

 

Cardiovascular Investigations

 

Path

Imaging

Proc

Micro

 

 

 

 

Cardiovascular Management

 

General

Meds

Surgery

Proc