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    Cardiovascular Examination

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    drskdcrdio6012
    This document outlines the key components of a cardiovascular examination, including: gathering a detailed history of symptoms like chest pain, dyspnea, palpitations; examining pulse, blood pressure, jugular veins, heart sounds and murmurs through inspection, palpation, and auscultation of the chest; and evaluating other organ systems for signs of heart failure or other cardiovascular issues. The physical exam aims to characterize symptoms, identify abnormalities in heart rate and rhythm, detect murmurs or other sounds, and look for signs of organ damage or dysfunction.

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    Cardiovascular Examination

    Uploaded by

    drskdcrdio6012
    1K views38 pages
    This document outlines the key components of a cardiovascular examination, including: gathering a detailed history of symptoms like chest pain, dyspnea, palpitations; examining pulse, blood pressure, jugular veins, heart sounds and murmurs through inspection, palpation, and auscultation of the chest; and evaluating other organ systems for signs of heart failure or other cardiovascular issues. The physical exam aims to characterize symptoms, identify abnormalities in heart rate and rhythm, detect murmurs or other sounds, and look for signs of organ damage or dysfunction.

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    This document outlines the key components of a cardiovascular examination, including: gathering a detailed history of symptoms like chest pain, dyspnea, palpitations; examining pulse, blood pressure, jugular veins, heart sounds and murmurs through inspection, palpation, and auscultation of the chest; and evaluating other organ systems for signs of heart failure or other cardiovascular issues. The physical exam aims to characterize symptoms, identify abnormalities in heart rate and rhythm, detect murmurs or other sounds, and look for signs of organ damage or dysfunction.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT or read online from Scribd
    Download as ppt
    1K views38 pages

    Cardiovascular Examination

    Uploaded by

    drskdcrdio6012
    This document outlines the key components of a cardiovascular examination, including: gathering a detailed history of symptoms like chest pain, dyspnea, palpitations; examining pulse, blood pressure, jugular veins, heart sounds and murmurs through inspection, palpation, and auscultation of the chest; and evaluating other organ systems for signs of heart failure or other cardiovascular issues. The physical exam aims to characterize symptoms, identify abnormalities in heart rate and rhythm, detect murmurs or other sounds, and look for signs of organ damage or dysfunction.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT or read online from Scribd
    Download as ppt
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    Cardiovascular

    Examination
    History
     Chest pain
     Dyspnoea
     Palpatations
     Oedema
     Syncope or presyncope
    Chest pain
    • Site and radiation
    • Character
    • Severity
    • Frequency
    • Duration
    • Aggravating factors
    • Relieving factors
    • Associated features
    Dyspnoea
    • Onset
    • Severity
    • Related to effort
    • Orthopnoea
    • Paroxysmal nocturnal dyspnoea
    Other symptoms
    • Cough
    • Haemoptysis
    • Tiredness
    • Nausea and vomiting
    • Bowel upset
    • Oliguria
    • Visual loss
    Other aspects of history
    • Past medical history
    • Drug history
    • Family history
    • Social history
    • Occupational history
    Physical examination
    • Look around
    • Hands, pulse, BP
    • Face & Neck
    • Chest examination
    • Other bits
    Look around
     Initial impression
    – Distress
    – Breathlessness
    – Audible cough
     O2
     TPR
    Hands
    • Perfusion
    • Peripheral cyanosis
    • Finger clubbing
    • Tar stains
    • Splinter haemorrhages
    • Xanthomata
    Pulse and BP
     Radial pulse
    – rate
    – rhythm
    – volume and character
     Central pulse
     BP
    – consider BP in both arms
    Face
    • Malar flush
    • Xanthelasma
    • Corneal arcus
    • Central cyanosis
    • Anaemia
    • Teeth – endocarditis
    JVP
    • JVP = right atrial pressure
    • Falls during inspiration
    • High in fluid overload e.g. right heart failure
    • Fixed in SVCO
    • Low in dehydration and fluid depletion
     45o – supine
     Inspect from side
     Internal jugular
    – Sternomastoid
     Height
     Waveforms
    The Heart
    • Inspection
    • Palpation
    • (Percussion)
    • Auscultation
    Inspection
    • Skeletal abnormalities
    • Scars
    • Pulsations
    • Pacemaker
    • Respiratory rate
    Palpation
    • Apex beat
    • Abnormal pulsations
    • Thrills
    • Parasternal heave
    Apex beat
    • Furthest point downwards and outwards
    • Normally 5th interspace in mid-clavicular line
    • Right hand placed on left chest wall
    • Middle finger over approx site
    • Once located count down the rib spaces
    • Displacement suggests cardiac enlargement
    • May be impalpable
    Auscultation
    • Diaphragm – high pitched sounds
    • Bell – low pitched sounds

    • Heart sounds
    • Added sounds
    Heart sounds
    • 1st & 2nd heart sounds usually audible at
    apex
    • “lub-dup”
    • Time with carotid pulse
    • Systole occurs between the heart sounds
    Listening
     Entire praecordium
    – Apex (mitral)
    – Lower left sternal edge (tricuspid)
    – Upper left sternal edge (pulmonary)
    – Upper right sternal edge (aortic)
     Identify S1 and S2
     Identify any murmurs
    Listening
    Listening
     Note features of murmurs
     (Carotids and axilla)
     Roll to the left (MS)
     Sit forward (AR)
    First heart sound
    • Mitral valve closure (end of atrial systole)
    • Tricuspid valve usually quiet
    • “lub” in lub-dup
    • Immediately precedes apical pulse
    • Immediately precedes carotid wave pulse
    • Apex with bell or diaphragm
    Second heart sound
    • Closure of aortic and pulmonary valves at
    end of ventricular systole
    • “dup” in lub-dup
    • Immediately follows apical impulse
    • Immediately follows carotid wave pulse
    • Upper left sternal edge with diaphragm
    Third heart sound
    • Normal in young healthy
    • Impaired LV function
    • Raised end diastolic pressure
    • Low pitched at apex – bell
    • “gallop” or “triple” rhythm when
    tachycardic
    Fourth heart sound
    • Accompanies and is due to atrial systole
    • Only heard in sinus rhythm
    • Loud in left atrial hypertrophy i.e. IHD,
    hypertension
    • Low pitched at apex – bell
    • Triple or gallop rhythm
    Heart sounds
    • Rate

    • Rhythm
    Sinus arrhythmia
    Ectopic beats – premature
    Intermittent heart block – dropped beats
    Atrial fibrillation
    Murmurs
    • Turbulent flow across valves
    • Leaking or narrowed valve
    • Timing
    • Intensity

    Grade 1 – very quiet


    ...
    Grade 6 – audible without stethoscope
    Systolic murmurs
    • Heard between 1st & 2nd heart sounds
    • Pan-systolic
    • Ejection systolic
    Pan systolic murmurs
    • Start with S1
    • Mid systolic accentuation
    • Extend through systole & continue to S2
    • Mitral regurgitation – apex, low pitched
    • Triscuspid regurg- left sternal edge to apex
    • VSD – rough, tearing with thrill
    Ejection systolic murmurs
    • Turbulent flow across narrowed valve
    • Onset after SI - distinct and separate
    • Intensity increases towards mid systole
    • Aortic stenosis – aortic area (carotid)
    • Pulmonary stenosis – pulmonary area
    Diastolic murmurs
    • Heard between 2nd & 1st heart sounds
    • Aortic regurgitation
    • Mitral stenosis

    • Pericardial friction rub


    Other findings
    • Carotid bruits
    • Pitting oedema (ankles & sacrum)
    • Chest auscultation
    • Abdominal examination
    • Peripheral pulses
    • Urinalysis

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