Cardio Examination

1. General Inspection
a. Laboured respiration
b. Cachetic (malignancy, severe cardiac failure)
c. Syndromes- marfans, Down’s, Turners
d. Pectus excavatum

2. Vital Signs

3. Hands (warmth, colour, capillary refill)

a. Nails
clubbing (cyanotic congenital heart disease, IE)
splinter haemorrhages
Quincke’s sign (capillary pulsation in nail bed ass. with AR)
b. fingers
oslers nodes
janeway lesions
tendon xanthomata (yellow deposits of lipid in the tendon accruing in
type 2 hyperlipdemia.)
c. Pulse (Radial)
Rate (brady, tachy)
Rhythm
Irregular irregular (AF)
Regularly irregular (wenkebach)
Radiofemoral delay (coarctation of the aorta -> congeital narrowing in
the aortic isthmus occurs @ the level of the ductus arteriosus meeting
the descending aorta)
Radial-radial delay (dissecting aorta, atherosclerosis, aneurysm,
subclavian artery stenosis)
Arm
BP lying and standing
Collapsing pulse (arm lifted above head -> AR)
Postural hypotension -> hypovolemia, drugs, Addison’s, hypopituitarism,
autonomic neuropathy
face
Jaundice (hepatic congestion, prosthetic heart valves), mucous membranes
Xanthelasmia (introcutaneous yellow cholesterol deposits around the eyes ->
hyperlipidemia)
Mitral faces (rosy cheeks with bluish tongue form dilation of the malar
capillaries -> pulmonary hypertension and low cardiac output states like mitral
stenosis)
Mucus membranes (anemia)
Argyil Robertson pupils (absent light reflex with an intact
accommodation reflex - AR from syphilis)
Mouth
High arch palate (Marfans)
Dentitia (source of infection for IE)
Central cyanosis
Petechiae on mucosa (IE)
 Moist mucous membranes

Neck
Carotid character
Anacratic (small volume, slow uptake, notched upstroke) -> aortic
stenosis
Plateau (slow upstroke) -> aortic stenosis
Bisferiens – AR and AS (anacratic and collapsing)
Collapsing -> AR, hyperdynamic circulation, PDA, atherosclerotic
aorta
Small volume -> AS, pericardial effusion
Alternans -> alternating strong-weak beats – LVF
Jerky -> hypertrophic cardiomyopathy
JVP
If more than 3cm -> right heart filling pressure is raised
Causes of elevated central venous pressure
Right ventricular failure
Tricuspid stenosis or regurg
Pericardial effusion/pericarditis
SVC obstruction
Hyperdynamic circulation
JVP character
Dominant a wave -> TS, pulmonary stenosis, pulmonary
hypertension
Cannon a wave – caused by atrial contraction against closed
tricuspid valve -> complete heart block, ventricular tachy with
retrograde atrial contraction
Dominant V wave – TR
X descent –
exaggerated -> tamponade, pericarditis
absent – AF
Y descent
Sharp – severe TR, constrictive pericarditis
Slow – TS, right atrial myxoma
Hepatojugular reflex -> push for 15sec over liver -> JVP will
normally decrease unless severe right sided ventricular failure

7. Praedcordium
Inspection
- scars
- pectus excavatum
- Kyphoscoliosis
- Pacemaker
- Visible apex beat/thrills/heaves

Palpation
- apex beat: palpate with finger tips, most lateral and inferior point at
which the fingers are displaced with each beat
o causes of a displaced apex beat: enlargement, chest wall
deformity, pleural and pulmonary disease
- Character of apex beat
o Pressure loaded- AS, HTN
o Volume loaded (thrusting), displaced, diffuse, non-
sustained- MR, dilated cardiomyopathy
o Dyskinetic