1. Cardiac Exam

2. WIPE End-of-bed Hands Arms Face Neck Chest Inspect Palpate Auscultate Back Completion Nails Heart Failure or Shock Valve Disease (Endocarditis) CAD (MI, Angina) Arrhythmia Congenital (Down’s & Marfan’s) Haem (Hb) Metabolic (Cholesterol) Wash hands, Introduce, Check Identity, Explain and Permission, Pain, Position (45 o ), Expose (chest) Fan Pillows Malar flushGTN Sweat/grey ECG stickersOn O2Pallor TemperatureOsler nodes Janeway lesions SweatyCyanosis Creases (Downs) Xanthomata Capillary RefillClubbing Splinter haemorr Clubbing Blood pressureCollapsing pulse (aortic regurg) Pulse rate & rhythm Radial-radial delay Malar flush Dentition Central cyanosis Arched palate Corneal arcus, pallor Xanthelasma Raised JVP? Do H-J reflex Carotid pulse for character & vol Apex beatValve op scarCABG scarPacemaker Apex beat Heaves Thrills Crepitations Sacral oedema Valve op scars Leg oedema CXR Fundoscopy Urine dip Leg CABG scar Tympanic temp Pulse oximetry 1. Mitral (bell) 2. Tricuspid 3. Pulmonary 4. Aortic INC CAROTIDS 5. Aortic sitting forwards 6. Mitral rolling away/axilla Koilonychia (↓Hb)

3. Murmurs, Valves, endocarditis….. …beyond what we have time for today. Make sure you listen in the correct place. And in the future, remember: RILE RIGHT sided murmurs are louder on INSPIRATION, LEFT sided murmurs louder on EXPIRATION AS MR ARM SAYS So Aortic Stenosis is an early/mid systolic murmur But Mitral Stenosis is a late diastolic murmur AS MR AR MS HS2 “Dub” HS1 “Lub” HS1 “Lub” Systole Diastole

4. Pulmonary = 2 nd L ICS Aortic = 2 nd R ICS Mitral = 5 th L ICS MCL Tricuspid = 4/5 th L ICS Tunstall & Shah 2012 Pocket Tutor: Surface Anatomy

6. Everyone will tell you different things; the books will all differ; assimilate the best things, and make your own routine PRACTICE your own routine; if you are confident, then it will convince the examiners