Cardiovascular system examination-medical physical examination
Before examining any system of the patient
- Wash your hands
- Introduce yourself to the patient
- Obtain consent
- Position the patient – 45 degrees
- Obtain adequate exposure
Components of cardiovascular system examination
- General examination
- Examination of pulse
- Measurement of blood pressure
- Examination of the Jugular venous pressure
- Examination of precordium
1. General examination
Examine patient from head to toe and look for
- Head – fever
- Conjunctiva – Pallor
- Tongue – central cyanosis
- Mouth – dental caries
- Nail – clubbing , peripheral cyanosis , splinter haemorrahge ( evidence of bacterial endocarditis )
- Palm – Janeway lesions , Osler’s node( evidence of bacterial endocarditis )
- Lower limb – pitting oedema
2. Examination of peripheral pulse
Locate the site of main peripheral pulses
- Radial
- Brachial
- Carotid
- Femoral
- Popliteal
- Posterior tibial
- Dorsalis pedis pulses
Describe the
- Rate
- Rhytam
- Character
- Volume
- Presence or absence of radial – femoral delay
- Condition of the vessel wall
3. Measurement of blood pressure
- Measure blood pressure using spigmomanometer
4. Examination of jugular venous pressure
- Best examine with patient incline to 45 degrees
6. Examination of precordium
Inspection
Look for
- Chest deformities -Pectus excavatum , Pectus carinatum
- Visible pulsation
- Surgical scars
- Breathing pattern
Palpation
Locate the apex beat ( lowest and outermost point of cardiac impulse )
- Keep right palm over the chest and feel the apex beat
- Count the intercostal spaces with the other hand to locate the site of apex beat
- Obtain a mid line of clavicle see whether the apex beats at the mid clavicular line
- Palpate trachea in the suprasternal notch and decide the position of the trachea. ( To get an idea of the mediastinum )
- Palpate other other area of precordium to to detect palpable murmurs ( thrill )
- Palpate to detect parasternal heave
Auscultation
- High pitch sounds are heard well with the diaphragm
- Low pitch sounds are best heard with the bell
- Ausculatary area of the precordium
- The mitral area ( apex ) – first heart sound
- The murmur of mitral valve best heard here
- The aortic area – in the second intercostal space immediately right to the sternum
- The murmur of aortic stenosis best heard here
- The Pulmonary area – is In the second intercostals space immedialty left to the sternum
- A pulmonary component of the second heart sound is best heard here
- The tricuspid area – is in the fourth intercostal space to the left of the sternum .
Labels: CVS, CVS Revision