Cardio OSCE

WIPE
Don't forget to check patient tag

Cardinal symptoms

SOB
MMRC score!!!

Questions to ask:
Is cough productive? (pink, frothy sputum if cardiogenic)
Is breathing noticeable? (i.e. chronic +++ work of breathing)
Is dyspnoea CARDIOgenic or PULMOgenic?
- Cardiogenic SoB = 70% association w/ PND and orthopnea

Edema
Proximal progression

Do you have difficulties putting on your shoes?
Increase in weight? (per fluid retention)

When is the swelling worst? (typically worse at the end of the day, and better in morning as edema is redistributed systematically)

Syncope

Duration
Onset
Triggers
Associations

Arrhythmias

Establish chronology:
- Onset, timing

Tap out HR.
Associated dizziness?

Fatigue

Determine per exercise tolerance.
Is fatigue caused by:
- SoB?
- Angina? (Canadian cardiac score)
- or claudication?

Intermittent claudication

MUST ASK ABOUT THE 6 P's of PVD:
P ain
P allor
P ulselessness
P aresthesia
P aralysis
P erishingly cold

Then Durp the derp:
D istance before onset?
U phill walking?
R esting claudication (severe occlusion)
P lace of pain (i.e. anatomical location)

PMH

Drug hx

F Hx

Social Hx

RoS

ICE

Thank the pt
Clean your hands
Summarize findings

1) WIPE

- Ask about pain/discomfort!!!
- Pt to be seated at 45 degrees
- Place, person, time!!!

2) General observation

Patient

Distress?
Cachetic?
Edematous?
SoB?
Marfan's? (Tall w. kyphosis)
Down's?
TED socks?
Cath'ed?

Surroundings

Oxygen?
Walking aids?
IV?
Fluid restriction?
Sputum mug?
Call button?
End of beds?

3) Hands

Temperature
Nicotine staining
Cyanosis
Cap refill
Splinter haemorrhages
Janeway lesions/Osler nodes
Palmar crease pallor

Should you run out of things to say, mention cardiogenic liver failure (i.e. per RHF):
Leukonycia
Koilnonychia

Pulse:
- Rate
- Rhythm
- Character
- Delay

4) Arms
No spider naevi

4) Offer to take BP

How-to

Sounds

5) Face

Eyes

Conjunctival icterus
Conjunctival pallor
Xanthelasmata

Cheeks

Malar flush

Mouth

Peripheral cyanosis
Central cyanosis
Dental caries
Marfan's high arched palate
Fetor hepaticus

6) Neck
- raised JVP

EXPOSE THE PATIENT

7) Chest:
- Look
- Feel
- Listen

General observation:
- Scars?
- Pacemaker?
- Visible apex beat?

Palpation:
- Apex beat (displaced?)
- Heaves
- Thrills

Heaves = RV enlargement

Thrills = Palpable mumurs @ AV, PV

Auscultation:
Remember to auscultate while feeling pulse!

S1 = Start of systole
- MV, TV
- Soft S1 = Heart block

S2 = End of systole
- PV, AV
- Loud S2 = HTN
- Soft S2 = Heart block
- Ask pt to INHALE DEEPLY to split S2 (A2 --> P2). Best
appreciated over PV
i. Pulmonary stenosis
ii. VSD
iiii. R BBB

Additional HS:
i. Opening snap: (Occurs post S2; Mitral stenosis)
ii. Mid systolic click (MVP)
iii. S3 = FUCK...you're screwed (Ventricular dilatation)
iv. S4 = well FUCK...you (Ventricular hypertrophy)

Offer to listen to lung sounds for Bi-basal creps.

8) Reverse WIPE:
- Wash your filthy hands.
- Thank the patient.
- AND FOR THE LOVE OF GOD MAN, GIVE THE PATIENT HIS
DAMN SHIRT BACK
- Summarize findings.