CVS station clinical findings

Inspection: Overweight gentleman, 10 inch midline scar on central chest1, Bruises over hands and arms2 Hands and nails: warm, well-perfused Radial pulse: regular, 80bpm Collapsing pulse: No Radial-radial/radial-femoral delay: not present BP: 148/90 Eyes: corneal arcus Mouth: no central cyanosis, good oral hygiene JVP: 3cm Carotid pulse: normal character, 80bpm Chest inspection: scar Apex: 5th intercostal space, midclavicular line Parasternal heaves/thrills: None Auscultation: S1 normal, ejection click, ejection systolic murmur with ticking sound3 Back inspection: no scars, good chest expansion Lung percussion/auscultation: good air entry, vesicular breath sounds Sacral oedema: not present Ankle oedema: not present

Questions How would you complete this examination? (peripheral vascular exam/fundi) Which investigations? (FBC, ECG, CXR, Echo) What are your findings? These are consistent with....? (Aortic valve replacement) Why would this man require a valve replacement (aortic stenosis/regurgitation) How would you know if the valve was no longer working (signs of aortic regurg- collapsing pulse and early diastolic murmur)

1. Midline sternotomy scar from aortic valve replacement 2. From anticoagulation 3. Mechanical aortic valve replacement

Please examine this 73-year old mans cardiovascular system, and comment (at the end of your exam) on your findings and any other examinations or investigations you would like to perform.