Cardiovascular Assessment

What are the sources of information?

- History taking
- Physical assessment

What are you looking for when making an assessment on the arms and legs?

- Inspect
- Bilateral pulses
- Bilateral blood pressure

What are you looking for when making an assessment on the neck?

- Pulse
- Assess for JVD
- Carotid bruit

What are you looking for when making an assessment on the face?

- Colour
- Cyanosis (under tongue)
- Conjunctiva

What are you looking for when making an assessment on the chest?

- Inspect
- Palpate - base and apex of heart
- Auscultate

What are you looking for when making an assessment on the legs?

- Inspect
- Pulses - pedal, popliteal, femoral

What is Shamroth's window?

- Indicative of clubbing if absent which could indicate lung disease or hypoxaemia
- It can also be normal as a hereditary factor

When inspecting the hands what staining might we be looking for?

Nicotine staining

What is splinter haemorrhage indicative of?

Endocarditis, but can be related to trauma

What does JVD stand for?

Jugular Vein Distension

What does JVP stand for?

Jugular Vein Pressure

What is carotid bruits?

A murmur heard over the carotid artery on auscultation during systole

What is xanthelasma?

A harmless yellow growth that appears on the corners of the eyelids due to cholesterol build up under the skin

Where can you see central cyanosis?

- Lips
- Under tongue

Where can you hear the aortic valve?

- Second intercostal space, right sternal border
- Aortic valve is heard hear during S2

Where can you hear the tricuspid valve?

- Fifth intercostal space, left sternal border
- Tricuspid valve is heard hear during S1

Where can you hear the mitral valve?

- Fifth intercostal space, mid-clavicular line
- Mitral valve is heard hear during S1

Where can you hear the pulmonary valve?

- Second intercostal space, left sternal border
- Pulmonary valve is heard hear during S2

What is Erb's point?

- Third intercostal space, left sternal border
- Hear you can hear both heart sounds with equal clarity

What heart sounds are you listening for?

- Lub dub
- Murmurs

What are you examining for to show poor signs of circulation in the legs?

- Cyanosis
- Varicose veins
- Pitting oedema
- Ulceration

What are the pulse sites in the legs?

- Dorsalis Pedis
- Posterior tibial
- Popliteal
- Femoral

What is the other name for pitting oedema?

Cor pulmonale

What is pitting oedema a sign of?

Right sided heart failure

What can happen if the right ventricle fails?

- Long-term high arterial pressure in pulmonary circulation
- Blood builds up in veins
- Fluid pushed out into tissues, visible as swelling to feet/ankles initially

What does a raised JVD/JVP indicate?

- Pulmonary hypertension
- Right-sided heart failure/cor pulmonale
- Tricuspid valve stenosis
- Superior vena cava obstruction
- Pericarditis 

What can cause unequal pulse pressures?

- Unilateral development of atherosclerosis
- Vascular occlusion – embolism
- Thoracic aortic aneurysm
- More significant (and detectable) for patients with hypertension, or other risk factors such as diabetes or high cholesterol

What is a DVT?

A clot that forms in a vein, usually in the legs

When is a DVT more likely?

- Over 60
- Overweight
- Smoker
- Take OCP (oral contraceptive) or HRT (hormone replacement therapy)
- History of cancer or heart failure
- Varicose veins

What other factors can cause a DVT?

- Recent surgery
- Bed-bound
- Recent long plane, train or car journey
- Pregnant, or delivered in past 6 weeks
- Dehydration

What score can be used to determine the risk of a DVT or PE?

Wells score