GUIA DE OSCE (Objective Structured Clinical Examination) - EXAME CARDIOVASCULAR

Introduction

Introduce yourself

Explain what you would like to examine

Gain consent

Place patient at 45° with chest exposed

Ask if patient has any pain anywhere before you begin!

General Inspection

Bedside for treatments or adjuncts – GTN spray, O2, Tablets, Wheelchair, Warfarin

Comfortable at rest?

SOB

Malar Flush

Chest for scars & visible pulsations

Legs for harvest site scars and peripheral oedema

Hands

Temperature - poor peripheral vasculature

Capillary refill – should be <2 seconds

Colour – cyanosis

Clubbing

Splinter haemorrhages, Jane-way lesions, Oslers Nodes – infective endocarditis

Palmar Erythema – hyperthyroidism, pregnancy, polycythaemia

Nicotine Staining – smoker

Pulses

Radial Pulse – rate & rhythm

Radial-Radial Delay – aortic coarctation

Collapsing Pulse – aortic regurgitation

BP – narrow pulse pressure = Aortic Stenosis | wide pulse pressure = Aortic Regurgitation

Carotid – character & volume

JVP – measure and also possibly carry out hepatojugular reflex

Face

Eyes – conjunctival pallor, jaundice, corneal arcus, xanthelasma

Mouth – central cyanosis, angular stomatitis

Dental hygiene – infective endocarditis

Close Inspection of Chest

Scars - lateral thoracotomy (mitral valve), midline sternotomy (CABG), clavicular (pacemaker)

Apex beat – visible in aortic regurgitation and thyrotoxicosis

Chest wall deformities – pectus excavatum, pectus carniatum

Palpation

Apex beat – 5th intercostal space, mid clavicular

Heaves- left sternal edge – seen in left & right ventricular hypertrophy

Thrills – Palpatable murmurs over aortic valve & apex

Auscultation

Listen over 4 valves - ensure palpation of carotid pulse to determine first heart sound

Roll onto left side & listen in mitral area – mitral stenosis

Lean forward & listen over aortic area- aortic regurgitation

Carotids - radiation of aortic stenosis murmurs & bruits

Lung bases – pulmonary oedema

Sacral Oedema & Pedal Oedema

To complete the examination

Thank Patient

Wash hands

Summarise Findings

Say you would

Assess peripheral pulses

Carry out an ECG

Dipstick urine

Bedside Blood Glucose

Fundoscopy