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Cardiology OSCEs Sadhika Laxman (FY1 Doctor, Bolton)Contents ● Full Cardiovascular Examination ○ Murmurs ● A to E examination ○ Acute Coronary Syndrome ○ Heart Failure ● Peri-Arrest GuidelinesClinical Signs on Cardiovascular Exam Inspect - general and targeted Palpate AuscultateHands and Arms ● CRT ● Pulse - rate, rhythm, volume, character, symmetry ● BP - high/low, symmetry, LSBP ● De-Quincke’s sign (AR)Face, Neck and Eyes ● JVP + hepatojugular reflex -> right/left ventricular failure, constrictive pericarditis ● Carotid Pulse - character, corrigan’s sign (AR)Chest ● Palpate ○ Apex beat - can turn them to the left as well ○ Heaves (hand feels lifted during systole) ○ Thrills (palpable murmur) *stenosis -> heave (hypertrophy) *regurg -> displaced apex beat (dilation)Auscultation 1. Aortic 2. Pulmonary 3. Tricuspid 4. Mitral - Listen with diaphragm - Listen to tricuspid and mitral with bell - Left lateral position - diaphragm - Erb’s point - right upper sternal edge (AR) - Carotids - diaphragmFinal Steps 1. Auscultate bases of lungs 2. Assess for pedal or sacral oedema 3. Summarise + additional assessments a. Full history b. Respiratory exam c. 12 lead ECG d. Peripheral vascular examABCDE ExaminationOverview SAMPLE Hx - symptoms, allergies, medications, PMHx, last meal, events leading up to now AIRWAY - are they talking? additional sounds? angiooedema? respiratory distress? BREATHING - trachea, chest expansion, percussion, auscultation, RR, SPO2 -> interventions: 15L NRB, CXR, ABG CIRCULATION - CRT, pulse, BP, HS, Abdomen, Calves -> interventions: ECG, catheter, IV access + bloods, 250-500ml 0.9% NaCl STAT DISABILITY - AVPU/GCS, Glucose, Eyes, Drugs (AGED) EXPOSURE - temperature, bleeding, rashes etc **ALWAYS ESCALATE TO THE RELEVANT SENIOR EARLY**Acute Coronary Syndrome Main Investigations ECG Troponin (0, 3/6h) + VBG (incl other bloods)Acute Heart Failure ● Pitting oedema ● SOB, PND, orthopnoea ● Bibasal crackles OR reduced basal breath sounds ● Hx of HF, MI, COPD, being given IVF *New presentation OR exacerbation● Daily weights ● Daily U+Es ● Cardiology referralPeri-Arrest/Arrythmia GuidelinesT c y r h h m s a i t h r y r BVagal Manouvres ● Blow into 10-20ml syringe ● Carotid massage ● Pinch nose and breath in ● Ice to neck (kids)Heart BlockBasics for OSCEsUseful Resources ● Life in the Fast Lane (ECGs) ● Geeky Medics ● Zero to Finals (really good for heart failure and murmurs) ● BMJ Best Practice ● OSCE Stop ● Passmed Good Luck!! Feedback: https://forms.gle/3G6RrQVwAki7CG4ZA