Cardiovascular examination:

General inspection

·      Conscious state: ↑↓↔

·      Respiratory effort: ↑↓↔

·      Colour: pink, pale, blue

·      Body habitus: ↑↓

·      Syndrome: acromegaly, Down’s, Turner’s

Vital signs

·      Heart rate

·      Blood pressure +/- both arms

Hands

·      Radial pulses, radiofemoral delay

·      Capillary refill time

·      Stigmata: clubbing, JW, ON

Head and neck

·      Eyes: conjunctival pallor

·      JVP: height, waveform

·      Carotid pulses: volume, thrill

·      Stigmata: high arched palate, malar flush, dentition

Praecordium

·      Inspection: surgery, pacemaker, deformity

·      Palpation: apex beat 5th ICS MCL, heave, thrill

·      Auscultation: four spots + carotid + axilla; S3 or S4, murmur

·      Dynamic change: inspiration, expiration, Valsalva

·      Postural change: left lateral, sitting forward

Chest

·      Inspiratory crackles

Abdomen

·      Hepatomegaly

Lower limbs

·      Pulses

·      Oedema

Bedside tests

·      ECG

·      TTE

 

Jugular venous pressure:

Waveform

A wave

·      Atrial contraction

C wave

·      Closure of tricuspid valves

X descent

·      Atrial relaxation

V wave

·      Bulging of tricuspid valves during isovolumic contraction

X’ descent

·      Elongation of atrium during systolic ejection

Y descent

·      Opening of tricuspid valve

 

Common abnormalities:

Atrial fibrillation

·      Absent A wave

Pulmonary hypertension

·      Large A wave

Pericardial tamponade

·      Reduced or absent Y descent

AV dissociation

·      Cannon A wave

Tricuspid regurgitation

·      Large

Tricuspid stenosis

·      Large A wave

 

Common valvular lesions:

 

Aortic stenosis:

Symptoms

·      Angina

·      Syncope

·      Dyspnoea

Signs

·      Small volume, late-peaking pulse

·      Hyperdynamic, displaced apex beat

·      Ejection systolic murmur at RUSB radiating to carotid, +/- thrill

Severe

·      Weak pulse

·      Late peaking murmur

·      Thrill

·      Soft S2

 

Mitral regurgitation:

Symptoms

·      Fatigue

·      Dyspnoea

Signs

·      Weak pulse

·      Displaced, hyperdynamic apex beat

·      Soft or absent S1; S3 present

·      Pansystolic murmur at apex radiating to axilla, +/- thrill

Severe

·      Weak pulse

·      Loud S3

Complications

·      LV failure

·      Pulmonary hypertension

·      Atrial fibrillation

 

Aortic regurgitation:

Symptoms

·      Fatigue

·      Dyspnoea

·      Palpitations

·      Angina

Signs

·      Water hammer pulse, wide pulse pressure

·      Displaced, hyperdynamic apex beat

·      Decrescendo diastolic murmur LLSB (?)

·      S3

Severe

·      Collapsing pulse, very wide pulse pressure (>80)

·      Bisferiens carotid pulse

·      Long murmur

Cause

·      Infective endocarditis

·      Marfan’s syndrome

Complications

·      LV failure

 

Mitral stenosis:

Symptoms

·      Fatigue

·      Dyspnoea

·      Orthopnoea

·      Paroxysmal nocturnal dyspnoea

Signs

·      Palpable ‘tapping’ apex beat

·      Opening snap, loud S1

·      Long diastolic murmur at apex +/- thrill

Complications

·      Atrial fibrillation

·      Pulmonary hypertension

 

 

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