Physical Examination of

cardiovascular system

By
Dr : Rofida ALWard
Objectives

 At the of this lecture the students should :

 Be able to recognize and summarize the general physical signs of patient with
cardiac problem .
 Be able to do a proper and systematic local examination of the pericardium .
 Be able to present an informative summary of the findings .
Before you start the examination :

 Great the patient and Introduce your self .

 Take the permission and explain what to do .
 Wash and worm your hands.
 Stand at the right side and exposed the patient .
General examination of cardiovascular
system :
 General assessment ( ABCDE) .
 vital signs.
 Anthropometric measurement .
 Regional examination from the head to toe .
Regional examination:

 Hands :-
 Temperature : hotness in in infective endocarditis , pericarditis .
 Sweating : heart failure .
 Edema or muscle wasting .
 Jaundice : in RHF.
 Pallor : due to anemia of chronic disease. .
 Peripheral cyanosis and clubbing : in cyanotic CHD , pale clubbing : IE .
 Signs of IE :
1- splinter hemorrhage .
2- oslar nodes .
3-janeway lesion .
Regional examination:

 Face :

 Jaundice and pallor in the eye and sub mucous membrane .

 Conjunctival hemorrhage or petechia : in IE .
 Roth spots: in retina by fundoscopy in IE .
 Malar rash in MS .
 Central cyanosis in CHD .
 Oral hygiene for IE .
Regional examination:

 Neck :
 Pulsation : carotid and JVP.
 Cervical lymph nodes .
 Thyroid gland examination .

 Lower limbs :
 clubbing , cyanosis .
 Bilateral lower limb edema: HF .
 Erythema marginatum : rheumatic fever .
 Local Examination of Pericardium:

 Inspection:
 Chest deformity :
- Ant : pectus carinatum , pectus excavatum.
- Post : kyphosis , scoliosis .
 Pericardial bulge .
 Skin :
- Scar , nodules , dilated veins.
 Visible pulsation :
- Normal : in mitral area of apex beat , in epigastric and suprasternal notch in thin
patient .
 Palpation :
 Pulsation :
1 - Mitral area (Apex beat) :
o Normal: palpable in the left fifth ICS midclavicular line .
slight elevation in character .
localized
o Abnormal :
- impalpable in pericardial effusion .
- displaced downward and laterally in left ventricular hypertrophy .
- character : tapping in MS ,
2- Tricuspid area:
o Normal :impalpable .
o Abnormal : palpable .
3- pulmonary area :
o Normal : impalpable .
o Abnormal : palpable as in pulmonary HTN .
4- Aortic area :
o Normal : impalpable .
o Abnormal : palpable as in HTN .

 Thrill : palpable murmur .

 Parasternal heave : as in RVH.
 Auscultation :
 Normal heart sounds :
- First heart sound S1 .
- Second heart sound S2.
- Third heart sound S3 in children and young adult , pregnancy , athletics , fever.
 Abnormal heart sounds :
Third heart sound .
Fourth heart sound .
 Added sounds:
Opening snap in mitral stenosis, ejection click , pericardial rub .
 Murmur :
- Time: systolic or diastolic.
- Radiation .
- Character.
Causes ??
Grades ?
How to proceed the pericardium
examination ?
Thank you for your attendance