Dept of Internal Medicine
Cardiovascular examination
From Talley and O’Connor 6th Edition
Sem 4 GKV
Dr Scarpa Schoeman
0823787333 or [email protected]
Dept of Internal Medicine
UFS
Dept of Internal Medicine
Overview
• Prep for the examination sessions PLEASE
• Talley and O’Connor - ! Yes please ! – DVD and text.
• MUST understand cardiac cycle.
• There are variations in practice – (it will confuse you
probably)
• PLEASE ASK QUESTIONS!!!!!!
Dept of Internal Medicine
Overview
Taken from:Evans, D. E., & Brown, J. (2009). How to succeed at medical school : an essential guide to learning (p. ix, 179 p.). Oxford: Wiley-Blackwell.
Evans-Brown Model to learn clinical skills
Dept of Internal Medicine
Overview
Basic Science
StepsClinical
Reasoning
Michels, M. E. J., Evans, D. E., & Blok, G. A. (2012). What is a clinical skill? Searching for order in chaos through a modified Delphi process.
Sem 1-5 Anatomy + Physiology
p102 (TC 6th edition)Sem 5+ = Experience!!
Dept of Internal Medicine
Cardio exam• INTRODUCTION (name and role)
• INFORMED CONSENT
• Ask pt to undress & CLEAN HANDS (you)
• Inspection
• Palpation
• Percussion
• Auscultation
• Thank pt and help to get dressed
Dept of Internal Medicine
Cardio exam• From the bedside (Insp)
• Level of illness – acute, chronic, acute on chronic
• Additional stuff - O2, tubes!• Chest wall – scars, deformities, lumps, pulsations
• Hands & Wrists (Insp) • Clubbing• Cyanosis (peripheral) • Splinter bleeds, Osler nodes, Janeway lesions(IE) • Tar staining (smoking)• Palmar erythema (red palms)
Dept of Internal Medicine
Cardio exam• Hands & Wrists (Palp)
• Cap refill (<2sec), temp of hands, • PULSES
• Rate (30 sec: REGULAR pulse, 1min IRREGULAR)
• Rhythm (AF!!)• Character and Volume (bigger artery)
• Hyperdynamic? Weak?• Rad/Rad & Rad/Fem delay (coarctation)
• Arms – BLOOD PRESSURE (p54-55)
Dept of Internal Medicine
Cardio exam• FACE
• Eyes• Anaemia + Jaundice• Arctus cornealis/senilis• Xanthelasma
• Cheeks redness (?mitral facies) • Mouth
• Lips – peripheral cyanosis• Tongue – central cyanosis• Bad teeth – site for bacteraemia• High arch palate (Marfan’s)
Dept of Internal Medicine
Cardio exam• NECK
• Carotid arteries palp (and Auscultation)• JVP (SUPER NB)
• Indication of RA pressure• 45° position is NB• Distance from RA to sternal angle(SA) = 5cm• Then vertical height above SA to max pulsation• POSITION yourself in top spot!
Dept of Internal Medicine
Cardio exam• Precordium
• Palpation• Z-manoeuvre (thrills and heaves)• APEX BEAT!!! • Percussion – not very useful at all
• Auscultate• M , T , P, A , Carotid (?stenosis)• Diaphragm (+bell for M)
• Manoeuvres• Left lateral – MS• Sitting forward - AI
Dept of Internal Medicine
Cardio exam• BACK
• Inspect: scars, deformities, lumps• Palpation
• Sacral oedema• Auscultate
• Breath sounds (? Different L vs R)• Fine basal creps = Pulm oedema (LHF)• Absent – percuss for pleural effusion
• ABDOMEN• Hepatomegaly? (Pulsatile liver – TI)• Splenomegaly?• Ascites?• Aorta aneurism• Fem arteries (palp and Ausc)
Dept of Internal Medicine
Cardio exam• LEGS
• Pulses present?• Toes (same as hand – not tar staining!)• DVT?• Ankle oedema (pitting 1-3+)
• Other• Fundoscopy• Urine dipstix• Temp (fever)
Dept of Internal Medicine
Overview
Basic Science
StepsClinical
Reasoning
Michels, M. E. J., Evans, D. E., & Blok, G. A. (2012). What is a clinical skill? Searching for order in chaos through a modified Delphi process.
p102 (TC 6th edition)
Dept of Internal Medicine
Overview
Taken from:Evans, D. E., & Brown, J. (2009). How to succeed at medical school : an essential guide to learning (p. ix, 179 p.). Oxford: Wiley-Blackwell.
Evans-Brown Model to learn clinical skills