MRCP PACES Cardio Exam
  • Positioning
    • Wash hands
    • 45°
    • Shirt off, trousers rolled up to above knees
  • General inspection
    • Scars
      • Midline sternotomy
      • Lateral thoracotomy
      • Implantable cardiac defibrillator
      • Saphenous vein / radial artery harvest scars
    • Malar flush
    • Corrigan’s sign
    • Giant v waves of tricuspid regurgitation
    • Implantable cardiac device
  • Hands
    • Stigmata of infective endocarditis
      • Janeway lesions – non-tender
      • Osler’s nodes – tender
      • Splinter haemorrhages
    • Clubbing
    • Pulse
      • Radio-radial delay
      • Rate
      • Rhythm
  • Head and neck
    • Conjunctival pallor
    • Central cyanosis, high-arched palate
    • Jugular venous pressure – waveform and height
      • Monophasic in atrial fibrillation
    • Carotid pulse character and volume
  • Chest
    • Inspection – scars, implantable cardiac device
    • Palpation
      • Apex beat – normal position is 5th intercostal space, mid-clavicular line
        • Character: heaving, thrusting, tapping, double impulse
      • Parasternal heave – right ventricular hypertrophy, pulmonary hypertension
      • Palpable thrills
    • Auscultation
      • Mitral area with bell (mitral stenosis) and diaphragm
        • Roll to the left and hold breath in expiration with bell (mitral stenosis)
      • Tricuspid area (diaphragm)
      • Pulmonary area (diaphragm)
      • Aortic area (diaphragm)
      • Carotid pulse
        • Carotid bruits
        • Radiation of aortic stenosis murmur
      • Lower left sternal edge, sit forward with breath held in expiration (aortic regurgitation)
  • Lung bases (pulmonary oedema)
  • Calves for pitting oedema
  • Complete examination: temperature, blood pressure, urine dipstick, fundoscopy (Roth spots)
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