1. Dept of Internal Medicine
Cardiovascular examination
From Talley and O’Connor 6th Edition
Sem 4 GKV
Dr Scarpa Schoeman or
Dept of Internal Medicine
UFS
Dept of Internal Medicine

2. 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

3. Dept of Internal Medicine
Overview
Evans-Brown Model to learn clinical skills
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.
Dept of Internal Medicine

4. Dept of Internal Medicine
Overview
Science
Basic
Steps
Reasoning
Clinical
Sem 1-5 Anatomy + Physiology
Sem 5+ = Experience!!
p102 (TC 6th edition)
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.
Dept of Internal Medicine

5. 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

6. 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

16. 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

17. 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

22. 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

25. 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

31. 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

32. 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

34. Dept of Internal Medicine
Overview
Science
Basic
Steps
Reasoning
Clinical
p102 (TC 6th edition)
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.
Dept of Internal Medicine

35. Dept of Internal Medicine
Overview
Evans-Brown Model to learn clinical skills
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.
Dept of Internal Medicine

36. Dept of Internal Medicine
Cardio exam
Many thanks!!!
Dept of Internal Medicine