1. By Sorcha Hodgson (checked by Rebecca Johnston FY1)
Cardio exam
By Sorcha Hodgson (checked by Rebecca Johnston FY1)

2. Introduction W- wash hands
I- introduce self, explain examination and GAIN CONSENT
P-position pt, check if they in any pain
E- expose patient (top off, supine 45 degree)

3. End of bed SAY WHAT YOU SEE!
Appearance of patient- unwell, distressed, cyanosed
What's around the bed- oxygen, egg monitor, fluids, catheter, medications especially GTN spray

4. Hands Temperature Capillary refill time Peripheral cyanosis
Tar staining
Palmar erythema
Janeway lesion
Osler nodes
Nails-
Koilonychia
Splinter haemorrhage
Clubbing
Oslers nodes- painful palpable nodes on ends of fingers
Janeway lesions-vascular phenomenon
Clubbing-
loss of normal angle at nailed (<165 degree) and boggy nail bed
Causes- IE, cyanosis CHD, atrial myxoma

5. Wrist Radial pulse Collapsing pulse
Rate- ?bpm
Rhythm- regular, irregular, irregularly irregular
Volume-normal, thready, bounding
Character-slow rising
Collapsing pulse
Radio-radial and radio-femoral delay

6. Arm BP
Brachial pulse

7. Face Malar flush Mouth Eyes Dentition Central cyanosis Corneal arcus
Xanthelasma
Conjunctival pallor
+ fundoscopy for Roth spots

8. Neck Carotid pulse JVP Pt head at 45 degree, turn to right
Look for double pulsation
Estimate height above stern all angle in cm- normally 3-4cm
Hepatojugular reflex

9. Chest Inspection Scars Palpation Apex beat Heaves Thrills
Pacemaker/ICD
Midline sternotomy- LOOK AT LEGS FOR VEIN HARVESTING NOW
Palpation
Apex beat
Heaves
Thrills
Vein harvesting- long saphenous
LMA- CABG
Valve replacement- metallic or tissue

10. Chest continued Auscultation Mitral- apex (B + D) Tricuspid- LLSE (D)
Pulmonary- 2nd left ICS (D)
Aortic- 2nd right ICS (D)
If feel radial pulse and is irregularly irregular- take heart rate by listening to the apex beat

11. Murmurs RILE Right sided murmurs loudest on inspiration
Left sided murmurs loudest on expiration
Presenting a murmur
T-timing- systolic/diastolic
I-Intensity-1-6
P-Position of stethoscope
P-Position of pt
Q-Quality
R-Radiation
S-Systemic

12. Back
Lung bases
Sacral oedema

13. Ankles Peripheral oedema
Signs of peripheral arterial or vascular disease

14. Conclusion
Present examination- most salient features first, important negatives
Review observation chart
Peripheral pulses
Investigations- ECG, CXR, echo, urinalysis, bloods
Management- dependent on findings

15. Possible questions Acute management of ACS Location of MI ECG findings
MONARCH I BE SICK FATTY
Location of MI
ECG findings
CHF management
AF management
Morphine-5-10mg
Oxygen
Nitrates-GTN
Aspirin 300mg
Ramipril
Clopidogrel 300mg
Heparin
IV GTN
Beta blocker
Sick- anti emetic
Fatty- statin