Describing Cardiovascular Findings

General Patient -Obvious Scar – “ On inspection I can appreciate a 5 cm midline scar

Observation that is well healed (erythematous, with exudate and necrotic tissue I
would like to observe closely)
-Obvious Mass- “ There is an obvious mass under the scar which I
will later inspect closely and palpate”
- No respiratory distress, adequately exposed and on 45o

Surrounding - Art Assist

- Pneumatic Sequential Compression

- TED stocking
- VAC dressing

- ECG electrode
- Oxygen
 - Urinary cathether
- Water jug + Medication
Hands Hands - Clubbing
(sign post) - Fluctuating Nail Bed (almost like pulsation) – Quincke sign
“So moving o “I can appreciate there is a
on to the Pulses - Rate
hand..” o “ Rate is ….”
- Rhythm “ Rhythm is ….”
o Regularly irregular
o Irregularly irregular
o Regular
- Character “ I can appreciate ……”
o Palvus Tardus
o Collapsing Pulse
o Radio-radial delay – Aortic Dissection
o Radio-femoral delay – Coarctation
Blood Pressure - EWS score shows High Systolic and Low systolic or normal
Systolic but High diastolic … is it of any help?
o Yes Pulse Pressure
o Wide pulse pressure – Aortic Regurgitation
o Narrow pulse pressure – Aortic Stenosis
Track mark - IVDU “ I can appreciate needle tracking marks on the
patient’s hand “
o Check Hands for splinter haemorrhages, osler nodes
and janeway lesion.
Neck Carotid Pulse - “ On inspection of the carotid there is an obvious pulsation
of the carotid artery” – Corrigan Sign
- “ The patient is nodding the head simultaneously with the
pulsation – De Musset’s sign
- “ I can also appreciate a raised JVP on the patient’s neck” –
underlying HF – Potential Q – Characteristics of a JVP ?

Face - “ There is a malar flush (plum red discolouration of the high

cheek)”
- “Patient’s uvula is pulsating” – Muller sign
- Some weird wonderful stuff to look out in Aortic
Regurgitation is secondary AR due to Syphilis
o Argyll Robertson Pupil – Dilated Pupil on light reflex
but accommodation pupil constrict ( Other name? )

Chest Inspection - Scar

o “ ____ cm scar on (midline/lateral side of the

chest/inferolateral to clavicle), well healed ( or if not
usually it will be erythematous, with discharge,
necrotic tissue).
1. Possible Q – Differential for each scar
 Midline – where else would you
check if there is a midline scar?
 Lateral
  Inferolateral to clavicle
2. Possible Q – Factor affecting wound healing



- Mass
o Underneath the scar
1. Usually is a cardiac device
 ICD
 Pacemaker
 Implantable Loop recorder – quite
rectangular looking
2. Possible Q – Difference between each – if
you mention so you need to know what it is!
-
Palpation - Apex beat
o Describe where it should be. Possible Q – Cause for
displaced apex beat?
1.
2.
3.
- Thrills & Heave
o If you can feel it it must be heard on auscultation.. if
in isolation might be normal

Auscultation - “ I can appreciate S1 + S2 no added sound can be heard “ ( if

normal
- Murmur - Aortic Stenosis
Grade o “ Harsh ejection systolic murmur heard all over
Character precordium but loudest in the aortic area. (If you
Consistent have the best ears and the best steths you might
with what appreciate splitting S2 but ESM is adequate but
Confirm know that the S2 can split!) The murmur radiates to
with Echo the neck. This is consistent with ---- AS” Possible Q –
- Heart differentiate AStenosis and Asclerosis?
sound - Aortic Regurge
o “I can appreciate a grade_____ ( hentam grade 3 and above, if loud give it a 3/4, if not so

early diastolic
loud might be 3..if you medical student marhaen can hear it it’s usually 3 and above)

murmur best hear as the patient sitting forword and

holding their breath at expiration…. this finding is
consistent with AR/A. Dissection and I would like to
check it with an Echo.”
- Mitral Regurge
o “ I can appreciate a soft S1 with a pansystolic
murmur ( maybe can say la – S2 cannot be
separated with the murmur). I can also appreciate a
galloping rhythm which consistent with S3. All these
are consistent with MR and I would confirm it with
an Echo.
Vascular Topic :

“ There is a midline scar extending from ______________ ( for example xiphisternum) to

__________ ( for example below umbilicus). Well healing/ poor healing?

Differential ?

“ I can appreciate 3cm old well healing vertical incision in the groin area.” (Well healing/ poor
healing? Old/New?)

Differential ?

Other possible Bypass

- Axillo- Femoral
- Fem- Fem
- Fem-Pop
- Fem- Distal Bypass