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Cardiovascular Examination
Cardiovascular Examination
THE HEART
For it is the heart by whose virtue and pulse the blood is moved, perfected, made apt to nourish and is preserved from corruption and coagulation. It is indeed the fountain of life, the source of all action. William Harvey 1578-1657
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Outline
Introduction General examination Examination of vessels
Arterial system Venous system
Precordial examination
Inspection Palpation Auscultation and Percussion??
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General examination
Examination of the hands Cyanosis (central and peripheral) Look for any malformation Examination of eye Examination of lower extremities
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Examination - Hands
Clubbing Splinter hemorrhages (infective endocarditis) Oslers nodes (tender) Janeway lesions (non-tender) Xanthomata (Hyperlipidemia)
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CLUBBING
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Oslers node
Janeway lesions
Splinter Haemorrhages
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Xanthelasma
Subconjuctival petechae
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Rhythm
Regular Irregular
Rate and rhythm are checked in the radial artery Character and volume assessed from carotid artery Radio-femoral delay (Coarctation of the aorta)-comparing radial and femoral pulse Peripherally accessible arterial pulses
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Cont
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Peripheral Pulses
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Cont
Steps
Position patient 30/45 Tangential light Identify internal jugular venous pulsation (right) Extend a long rectangular object or card horizontally from this point and a centimeter ruler vertically from the sternal angle, making an exact right angle. Measure the vertical distance in centimeters
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PRECORDIUM - INSPECTION
Precordium - Palpation
Point of maximal impulse (PMI)
Location Character
Heaving Thrusting Tapping localized/diffuse
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Auscultation
Proper auscultation requires Quiet area. Avoid extraneous noise from radios, televisions, .. The earpieces of the stethoscope are directed anteriorly or parallel to the direction of the external auditory canal
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Bell low pitched sounds Diaphragm high pitched sounds Mitral Tricuspid Pulmonary Aortic areas S1 (first heart sound) S2 (2nd heart sound) Lub-dub-lub-dub
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Heart Murmurs
Systolic
Pansystolic
Mitral regurgitation Tricuspid regurgitation Ventricular septal defect
Diastolic
Early diastolic
Aortic regurgitation Pulmonary regurgitation
Mid-diastolic
Mitral stenosis Tricuspid stenosis Atrial myxoma
Ejection systolic
Aortic stenosis Pulmonary stenosis HOCM Atrial septal defect
Continuous
Patent ductus arteriosus Arteriovenous fistula
Late systolic
Mitral valve prolapse
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Cont
Grading of Murmurs
1. 2. 3. 4. 5. Very faint, heard only with special effort Quiet, but readily detected Moderately loud Loud, usually accompanied by a thrill Very loud, with thrill, heard when the stethoscope is partly off the chest 6. Very loud, with thrill, heard when the stethoscope is entirely off the chest
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THANKS