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Cardio Exam


July 1st, 2020


When performing a cardiovascular examination, always ask to perform fundoscopy. This may reveal signs of diabetic or hypertensive nephropathy.
  • How to Perform

  • Dim the lights and examine the fundus using a traditional direct or PanOptic ophthalmoscope.
Dilate the eye if possible with tropicamide, atropine or phenylephrine eye drops.

Hypertensive Eye Changes

  • Look For

  • Silver wiring: glistening bronze / silver arterial walls
  • Arteriovenous nicking: arteries displacing veins at points of crossing
  • Flame-shaped retinal haemorrhages
  • Cotton wool spots: small white, cotton wool-like microinfarcts on the retina
  • Papilloedema: swelling of the disc with venous engorgement, cotton wool spots and haemorrhage
  • Grading of Hypertensive Retinopathy

  • Grade 1: silver wiring
  • Grade 2: arteriovenous nicking
  • Grade 3: flame-shaped haemorrhages, cotton wool spots
  • Grade 4: papilloedema

Roth Spots

Seen on fundoscopic examination, Roth spots are a pale patch to the retina with a surrounding ring of haemorrhage.
  • Significance

  • A peripheral sign of infective endocarditis.
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