Clinical Examination of Cardiovascular System
Cardiovascular System
Cardinal Symptoms
1. Breathlessness
2. Dyspnoea – Dyspnoea Is An Abnormal Awareness Of Breathing Occurring Either At Rest Or An Unexpectedly Low Level Of Exertion.
Orthopnoea – In Patient With Heart Failure Lying Flat Causes A Steep Rise In Left Atrial Pressure, Resulting In Pulmonary Congestion And Severe Dyspnoea.
PND – Frank Pulmonary Oedema On Lying Flat Wakes The Patient From Sleep With Distressing Dyspnoea And Fear Of Imminent Death. The Symptoms Are Corrected By Standing Upright.
3. Chest Pain
4. Palpitation– Awareness Of The Heart Beat.
5. Dizziness And Syncope; Black- Out
6. Swelling Of Feet Or Facial Puffiness
Scheme Of Examination
Pulse
Rate & Rhythm: Assessed By Palpating The Right Radial Pulse
Volume: Evaluated At Right Carotid Artery
Condition Of The Arterial Wall
Comparison between 2 Radial Pulses
Radiofemoral Delay
Examination Of Neck Veins –
Engorged Or Not
If Engorged,
Pressure
Pulsation- Present Or Not
Hepatojugular Reflux- Present Or Not
Examination Of The Heart–
Inspection
Inside The Precordium
Shape
Apical Impulse
Engorged Superficial Veins
Polythelia ( Accessory Nipple )
Any Scar Mark, Sinuses
Outside The Precordium-
Any Pulsation Present In- Aortic Area, Pulmonary Area, Right & Left Parasternal Areas, Epigastrium, Suprasternal Area, Carotid Areas, Back esp. At The Inferior Angle Of Scapula In Coarctation Of Aorta (Suzman’s Sign)
Back – For Scoliosis, Kyphosis, Gibbus, Drooping Of Shoulder, Winging Of Scapula, Skin ( For Sinus, Ulcer, Venous Or Arterial Prominence, Scar Mark).
Palpation
Mitral Area
Apex Beat – Site [ Left 5th Inter Costal Space, ½ “ inside the left mid-clavicular line ] & Character
Palpable Heart Sound (M₁)
Thrill
Pulmonary Area [ the Left 2nd Inter Costal Space (close to the sternum )]
Pulsation
Palpable Heart Sound (P₂)
Thrill
Aortic Area [ the Right 2nd Inter Costal Space(close to the sternum)]
Pulsation
Palpable Heart Sound (A₂)
Thrill
Tricuspid Area[the Left 4th Inter Costal Space(close to the sternum )]
Pulsation
Palpable Heart Sound (T₁)
Thrill
Direction Of Venous Blood Flow (In Engorged Superficial Veins )
Thrill In Carotid Arteries ( Carotid Shudder )
Epigastric Or Suprasternal Pulsation, Or Any Pulsation Over The Neck
Palpable Pericardial Rub
Tracheal Tug
Percussion – NOT DONE
Auscultation [Sequence: 1. APEX 2. TA 3. NA 4. PA 5. AA]
Cardiac Rate
Rhythm
Mitral Area
Heart Sound
Murmur
Adventitious Sound- Opening Snap, Ejection Click, Splitting Of Heart Sound, S₃ Or S₄
Pulmonary Area
Aortic Area
Tricuspid Area
Neoaortic Area [The Left 3rd Inter Costal Space (Close To The Sternum )]
Carotid Arteries For Bruit ( After Holding The Breath )
Pericardial Rub
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