After this course, you should seek to:

• List and describe key central cardiopulmonary, arterial and venous structures
• Outline the principal properties, relations and functional interactions of these structures
• Assess their status via case history, observation and appropriate testing
• Demonstrate key psychomotor skills relevant to your examination of the above
• Apply yourself to a novel theoretical clinical situation, demonstrating a synthesis of central cardiopulmonary knowledge and skills, testing any hypotheses you generate
• Explicitly analyse your diagnostic process, reflecting on its strengths and weaknesses
• Evaluate the bearing of these processes on your subsequent physiotherapeutic care

NB the above may be the subject of formative or summative assessment, in line with prevailing MACP guidelines


References

Visit as many of the references shown below as possible prior to your course. Some of the references are in text format, while others are graphical, tabular or pictorial. Our intention is to provide you with an assortment of information sources that you can choose from - and that you can match to your own learning style.

Example of Clubbing: Ref 4 pp 238-242

Examples of splinter haemorrhages: Ref 4 p 234

Examples of Spider Naevi: Ref 4 pages 287 and 290

Example of anaemia: Ref 4 pp 6 and 134

Examples of lipid deposition: Ref 4 p 98

The JVP: Ref 1 p 155

Examples of chest deformity: Ref 4 pp 269-273

Technique for the chest: Ref 1 p 118

Auscultation of the heart: Ref 1 p 157

Bring your own:

Stethoscope (preferably Littmann type)
Pen torch
Tongue depressors

Indications: Palpitations or chest pain; dyspnoea, syncope or dizziness
Oedema or circulatory disturbance
Urinary disturbance
Unexplained fatigue

• Structures involved
Heart, arterial and venous great vessels, peripheral vasculature and concomitant autonomic innervation to these structures. Contiguous viscera including lungs, liver, spleen and kidney.

• Examination of the extremities and face
Finger and toe clubbing, colour and temperature
Smoker’s face: Characteristic pattern of lines and colouration
Spider Naevi: Central feeder vessel with capillaries radiating from it
Buccal mucosae and tongue: Cyanosis, nicotine skin staining and anaemia

• The Neck
Venous assessment of ‘double-topped’ pulse in the jugular vein (internal - why this one?) Its use as a reflection of cardiac efficiency / health.
Examination of patient recumbent at 45 degrees - why this angle?
Associated phenomena such as ‘hepatojugular reflux’
Differentiation from carotid arterial pulse

• The Thorax
Gross shape and deformity such as ‘pectus excavatum’ (funnel chest) and kyphoscoliosis, altering the classical arrangement of internal anatomy
Pulsation and masses such as aneurysm and parasternal heave
Scars and vascularity due to previous injury, medical or surgical intervention
Functional affectations: asymmetrical respiratory movements due to scarring or as congenital or developmental anomaly.
Pulmonary oedema or pleural effusion: Basal auscultation and percussion

• The Heart
Palpation for the apex beat, thrills and gross pulsation.
How might altered function affect and be reflected by altered structure?
Percussion for coarse estimate of cardiac size
Auscultation for heart sounds, added sounds and murmurs
 

© Crawford & Cook 2005