Examination notes

What are the basic cardiac symptoms?

The main symptoms of cardiac disease are chest pain, shortness of breath, ankle swelling, orthopnoea, paroxysmal nocturnal dyspnoea, palpitations and syncope.

How do you prepare for the examination of the cardiac surgery patient?

The patient needs to be lying at 45° in underwear on the examination couch. The groins are covered but the legs are exposed.

What do you inspect in the examination of the heart?

1. • Jugular venous pressure (JVP). The patient is positioned at 45° with the head slightly turned to the contralateral side. Look for the JVP wave form and the height above the sternal notch. It should normally be seen 3 cm vertically above the sternal angle. A raised JVP is associated with congestive cardiac failure, pericardial tamponade or constrictive pericarditis. A collapsed JVP is caused by dehydration or shock.

2. • Identify scars from previous carotid endarterectomy.

3. • Inspect the chest for scars from previous cardiac or thoracic surgery.

4. • Inspect the legs for scars from previous saphenous vein harvest or varicose vein avulsions.

5. • The groins must be checked for evidence of previous vascular or endovascular surgery or percutaneous intervention.

6. • At the beginning or end of the examination the patient should be asked to stand, to look for varicose veins.