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Cardiology Examination

Learning Objectives. Learn how to do a Cardiology Examination. General Principles. Introduction General InspectionHand, Face, Neck, Close InspectionPalpationPercussion (less relevant)AuscultationEnd. Start. Wash HandsGreetingConsentExposure (Waist Upwards, and ankles)Position (45%). General Inspection.

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Cardiology Examination

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    1. Cardiology Examination

    2. Learning Objectives Learn how to do a Cardiology Examination

    3. General Principles Introduction General Inspection Hand, Face, Neck, Close Inspection Palpation Percussion (less relevant) Auscultation End

    4. Start Wash Hands Greeting Consent Exposure (Waist Upwards, and ankles) Position (45%)

    5. General Inspection Clues around the bedside Cyanosis (bluish tinge) Pallor Breathlessness

    6. Hands Temperature (warm or cool) Clubbing Cyanotic Congenital Heart Infective Endocarditis Atrial Myxoma Tobacco staining, tendon xanthomata Cap Refill

    7. Hands Signs of Infective Endocarditis: Splinter Haemorrhages Janeway Lesion Painless, palms Osler’s Nodes Painful, fingers and toes

    8. Pulse Rate, Rhythm, Radial-radial delay Radio-Femoral Delay Collapsing Pulse Do you have any pain in your shoulder? Waterhammer pulsation. Sign of Aortic Regurgitation

    9. Blood Pressure Ask to do this Say you would do both arms

    10. Face Inspect for mitral flush Eyes Corneal Arcus Conjunctival Pallor

    11. Neck Carotid Pulse, Volume and Character, don’t do both at once. JVP Pt should be at 45o Don’t confuse with the carotid pulse No more than 4cm above the sternal angle

    12. Close Inspection

    13. Palpation Heaves’ and Thrills Place hand flat on chest to left then right of sternum (warn patient) Heave: Sustained, thrusting usually felt at left sternal edge (= right ventricular enlargement) Thrill: Palpable murmur felt as a vibration beneath your hand

    14. Palpation Apex Beat (Lowermost lateral position) Normally 5th intercostal space in mid-clavicular line. NB Dextrocardia

    16. Auscultating the heart

    17. Auscultating the heart Palpate the pulse at the same time At apex listen with diaphragm and bell in left lateral position. Check for radiation to axilla Check carotids with bell Right sided murmur loudest in inspiration Lean forward for aortic and pulmonary regions.

    18. Heart Murmurs Rumbling mid-diastolic murmur = MITRAL STENOSIS Pansystolic murmur = MITRAL REGURGITATION Ejection Systolic murmur = AORTIC STENOSIS Early Diastolic Murmur = AORTIC REGURGITATION

    19. Heart Diagram

    20. End Check for Sacral Oedema, Auscultate lung bases, Check for Ankle Oedema

    21. To Complete Examination Examine the abdomen Peripheral vascular examination Temperature Chart Dip Urine Examine retina by fundoscopy

    22. Finally Thank patient and Wash Hand

    23. Now your turn!

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