Cardio Examination

8/6/2019 Cardio Examination

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Cardio Examination

1. General Inspection

a. Laboured respiration

b. Cachetic (malignancy, severe cardiac failure)

c. Syndromes- marfans, Down’s, Turnersd. Pectus excavatum

2. Vital Signs

3. Hands (warmth, colour, capillary refill)

a. Nails

clubbing (cyanotic congenital heart disease, IE)

splinter haemorrhages

Quincke’s sign (capillary pulsation in nail bed ass. with AR)

b. fingers

oslers nodes janeway lesions

tendon xanthomata (yellow deposits of lipid in the tendon accruing in

type 2 hyperlipdemia.)

c. Pulse (Radial)

Rate (brady, tachy)

Rhythm

Irregular irregular (AF)

Regularly irregular (wenkebach)

Radiofemoral delay (coarctation of the aorta -> congeital narrowing in

the aortic isthmus occurs @ the level of the ductus arteriosus meeting

the descending aorta)

Radial-radial delay (dissecting aorta, atherosclerosis, aneurysm,

subclavian artery stenosis)

Arm

BP lying and standing

Collapsing pulse (arm lifted above head -> AR)

Postural hypotension -> hypovolemia, drugs, Addison’s, hypopituitarism,

autonomic neuropathy

face

Jaundice (hepatic congestion, prosthetic heart valves), mucous membranes

Xanthelasmia (introcutaneous yellow cholesterol deposits around the eyes ->hyperlipidemia)

Mitral faces (rosy cheeks with bluish tongue form dilation of the malar

capillaries -> pulmonary hypertension and low cardiac output states like mitral

stenosis)

Mucus membranes (anemia)

Argyil Robertson pupils (absent light reflex with an intact

accommodation reflex - AR from syphilis)

Mouth

High arch palate (Marfans)

Dentitia (source of infection for IE)

Central cyanosisPetechiae on mucosa (IE)



Moist mucous membranes

Neck

Carotid character

Anacratic (small volume, slow uptake, notched upstroke) -> aortic

stenosisPlateau (slow upstroke) -> aortic stenosis

Bisferiens – AR and AS (anacratic and collapsing)

Collapsing -> AR, hyperdynamic circulation, PDA, atherosclerotic

aorta

Small volume -> AS, pericardial effusion

Alternans -> alternating strong-weak beats – LVF

Jerky -> hypertrophic cardiomyopathy

JVP

If more than 3cm -> right heart filling pressure is raised

Causes of elevated central venous pressure

Right ventricular failureTricuspid stenosis or regurg

Pericardial effusion/pericarditis

SVC obstruction

Hyperdynamic circulation

JVP character

Dominant a wave -> TS, pulmonary stenosis, pulmonary

hypertension

Cannon a wave – caused by atrial contraction against closed

tricuspid valve -> complete heart block, ventricular tachy with

retrograde atrial contraction

Dominant V wave – TR

X descent –

exaggerated -> tamponade, pericarditis

absent – AF

Y descent

Sharp – severe TR, constrictive pericarditis

Slow – TS, right atrial myxoma

Hepatojugular reflex -> push for 15sec over liver -> JVP will

normally decrease unless severe right sided ventricular failure

7. PraedcordiumInspection

- scars

- pectus excavatum

- Kyphoscoliosis

- Pacemaker

- Visible apex beat/thrills/heaves

Palpation

- apex beat: palpate with finger tips, most lateral and inferior point at

which the fingers are displaced with each beat

o causes of a displaced apex beat: enlargement, chest walldeformity, pleural and pulmonary disease



- Character of apex beat

o Pressure loaded- AS, HTN

o Volume loaded (thrusting), displaced, diffuse, non-

sustained- MR, dilated cardiomyopathy

o Dyskinetic

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Cardio Examination