This 10 minutes include: history, examination, diagnosis, management, educate patient and follow up planning, and also documentation. GPs are supposed to do selective examination. It takes fair a bit of experience in order to do that.
Anyway, the following is the standard approach to a cardiovascular examination. It is what is expected for RACGP exam.
The following notes are from Talley and O'Connor. It is an Australian textbook and it is mainly written for physician trainees. It is a bit too much for a GP but it is what it is needed for the exam. I was once told by a medical registrar, he watched one of Talley and O'Connor's videos every night when he was preparing for the physician exam. That is how he fit his study around his family life and work.
Cardiovascular examination step by step as per Clinical Examination by Talley and O'Connor:
- General inspection (lying at 45 degrees)
- Dyspnoea
- Cyanosis
- Marfan's, Turner's Down syndromes
- Rheumatological disorders e.g. ankylosing spondylitis (aortic regurgitation)
- Acromegaly
- Hands
- Clubbing
- Stigmata of endocarditis
- Peripheral cyanosis
- Pulses
- Rate and rhythm
- radial radial
- radiofemoral delay (if there is a history of hypertension)
- Measurement of BP
- estimating BP first by palpating radial pulse
- Face
- Sclerae - pallor (anaemia), jaundice
- Xanthelasma
- Malar flush (mitral stenosis, pulmonary stenosis)
- Mouth
- Cyanosis
- Palate (high arched - Marfan's)
- Dentition (risk of endocarditis)
- Neck
- Jugular venous pressure
- Central venous pressure height
- Wave form (especially large V waves)
- Abdominojugular reflux test
- Carotids - pulse character
- precordium
- Inspect
- Scars- whole chest, back
- Deformity
- Apex beat - position, character
- Abnormal pulsations
- Palpate
- Apex beat
- Character
- Thrill or parastenal impulse
- Auscultate
- Heart sounds
- Murmurs
- Position patient
- Left lateral position
- Sitting forward (forced expiratory apnoea)
- NB: palpate for thrills again after positioning
- Dynamic auscultation may be indicated (no GPs will do this)
- Respiratory phases
- Valsalva
- Exercise (isometric e.g. hand grip)
- Standing
- Squatting
- Back (sitting forward)
- Scars, deformity
- Sacral oedema
- Pleural effusion (percuss)
- Left ventricular failure (auscultate)
- Abdomen (lying flat - 1 pillow only)
- palpate liver (pulsatile etc), spleen, aorta
- Percuss for ascites (right heart failure)
- Femoral arteries - palpate , auscultate
- Legs
- Peripheral pulses
- Cyanosis, cold limbs, trophic changes, ulceration (peripheral vascular disease)
- Oedema
- Xanthomata
- Calf tenderness
- Clubbing of toes
Here you go. If you have 10 - 15 minutes to study, consider watching one of the examination videos. I always pick up a few things every time I watch it.
Reference:
Clinical examination by Talley and O'Connor
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