Cardiovascular history & examination

History taking
1.

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. 7.

Any claudication? Risk factors

1. 2. 3. 4. 5. 6. Smoke DM High BP Cholesterol Diet / exercise FH

HS and added HS

HS 1

Mitral and tricuspid closure When would it be loud?

MS, tachycardia, short PR interval, tachycardia MR, PR long

When would it be soft

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

Introduction

WASH HANDS Introduce Consent Expose

Offer them a blanket 45 degrees

Are you in any pain?

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

Inspection 2

Hands ctd

Eyes

Radio radial delay Radio femoral delay Lift arm up collapsing pulse

Anaemia Xanthalasma Corneal arcus Fundoscopy

Malar flush Dental hygiene

Arm

Face

BP

Neck

Tongue

JVP

Palpation

Apex beat

5th ICS MCL RVH Palpable murmur

Heaves

Thrills

Auscultate

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Auscultate 2

Diaphragm

Left lateral position

Mitral Tricuspid Pulmonary Aorta

Listen with the bell in mitral area in expiration

Listen in axilla with bell for radiation of mitral regurg murmur

Carotids

radiation of aortic stenosis

Sit up

Bell

Aortic Pulmonary Tricuspid Mitral

In tricuspid area, listen for AR in expiration Listen to bases of lungs Look for sacral edema Look at ankles for edema

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 and hepatomegaly in right heart failure Do respiratory exam looking for pleural effusion etc.

Murmurs
Type of murmur
Pan systolic Ejection systolic

Cause
Mitral / tricuspid regurgitation, VSD Aortic / pulmonary stenosis, HOCM, pregnancy Aortic/pulmonary regurgitation Mitral / tricuspid stenosis

Early diastolic Mid diastolic

Describing a murmur
1. 2. 3.

4.
5.

Position heard loudest Pitch Radiation Intensity (grade 1-6) Timing

1. 2.

Systolic Diastolic

Jugular venous pressure

Which vein is it

Internal jugular vein

Gives us an indication of RA pressure <4cm from angle of louis

Why are we examining it

Normal

What happens in inspiration to the JVP? Waveform

ASK ME

JVP waveform

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Differences: JVP and carotid

JVP
Character
Obliteration Position

Carotid
Single pulse
Cannot No effect

Respiration
Reflex Palpable pulse

Double pulsation Can be obliterated JVP falls if sit up JVP falls

Hepatojugular No

No effect
No effect Palpable

Increased or decreased JVP

Raised JVP with no waveform

SVC-O

Raised JVP with normal waveform

RHF Fluid overload

Lowered JVP

Shock

Thank you for listening

Any questions ??

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