Cardiology Exam

Intro

Candidate introduces self with full name and role

Adheres to appropriate infection control measures

Identifies patient with 2 pieces of information - eg name and date of birth

Gains consent

Initial Inspection

Assesses patient from the end of the bed

Identifies findings around the examination space e.g. Oxygen / IV's / medication

Peripheral Examination: 

Check hands e.g. splinter haemorrhage, janeway lesions/osler nodes, colour, warmth, clubbing

Cap refill

Skin Turgor

Radial pulse - comment on rate, rhythm, character, volume

Checks Radial-Radial delay

Checks for collapsing pulse (confirms no shoulder pain before performing)

Checks eyes e.g. conjunctival pallor / xanthalasma / corneal arcus / kayser-fleischer rings

Checks mouth e.g. mucous membranes / angular stomatitis / glositis / dental hygiene

Checks for mallar flush

Checks JVP (may comment on accentuation e.g. hepatojugular reflux. or positioning)

Cardiac Chest Exam: Look

Adequately exposes patient and visualised chest e.g. for implants / deformity / midline sternotomy / pacemaker or thoracotomy scars

Cardiac Chest Exam: Feel

Palpates Apex beat - usually felt at 5th IC midclavicular line

Palpates for parasternal heaves/thrills

Cardiac Chest Exam: Listen

Auscultates over the 4 valves and describes any murmur heard

Palpates peripheral pulse whilst listening

Auscultates carotids for bruit

Cardiac Chest Exam: Special Maneuvers

Performs accentuation manoeuvres if indicated

— accentuation over mitral area (roll laterally and listen in the axilla for mitral murmur with bell and diaphragm)

— accentuation over aortic area (sit forward for aortic murmurs using diaphragm)

— uses inspiration to make rIght sided murmurs louder, and exhalation to make left sided murmurs louder

Peripheral Examination continued

Listens to the chest bases for pulmonary oedema

Checks for sacral oedema and peripheral oedema in legs

Complete examination

Prompts patient to redress

Concludes by requesting further examinations e.g. peripheral vascular exam

Suggests Investigations e.g. gas, ECG, bloods, CXR, echo, ABPI, LSBP

Gives a differential diagnosis and management in a structured manner

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