Cardiovascular Physical

Examination

dr. AA Ayu Dwi Adelia Yasmin, M.Biomed, SpJP

Cardiovascular Department
Udayana University-Sanglah Hospital

The General Survey

Common symptoms
Chest pain
Shortness of breath
Palpitations

Face, Eye, Mouth

Jugular Venous
Pressure (JVP)
Kepala pasien dinaikkan 45
derajat.
Pencahayaan baik.
Identifikasi vena jugularis
interna.
Untuk menggambarkan
tekanan atrium kanan.
Zero point (Point of
Reference) = Angle of
Louis.

Hepatojugular reflux
Abnormal pada:

RV failure
RV infarct
Tricuspid stenosis
Tricuspid regurgitation
Pericardial effusion
SVC obstruction
Fluid overload

Inspeksi
Scars
Median sternotomy
CABG
Valve replacement

Lateral thoracotomy
Infraclavicular
(pacemaker)

Pectus excavatum
Pacemaker box
Apex beat

Sternotomy scar

Pectus excavatum

Palpasi
Apex beat
Location
Character
Left parasternal heave
Thrills (palpable
murmurs)
Systolic
Diastolic
Palpable P2 (pulmonary
hypertension)
Pacemaker box

Auskultasi
Bell low pitched
sounds
Diaphragm high
pitched sounds
Mitral Tricuspid
Pulmonary Aortic
areas
S1 (first heart sound)
S2 Splitting (A2, P2)

Abnormalitas Suara
Jantung

Loud S1
Soft S1
Loud A2
Loud P2
Soft A2
Splitting of S1
Increased splitting of S2
Fixed splitting of S2
Reversed splitting of S2

S3 (third heart sound)

S4 (fourth heart sound)
Summation gallop
Opening snap
Systolic ejection click
Mid-systolic click
Tumour plop
Pericardial knock
Metallic click

Auskultasi (Murmur)
Fase
Systolic
Diastolic
Continuous

Lokasi
Derajat
Grades I-VI
Thrill

Kualitas
Penjalaran
Manuver
Respiration
Left-sided on exp.
Right-sided on insp.

Valsalva
Squatting

Heart Murmurs
Systolic
Pansystolic
Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect

Ejection systolic

Aortic stenosis
Pulmonary stenosis
HOCM
Atrial septal defect

Late systolic
Mitral valve prolapse

Diastolic
Early diastolic
Aortic regurgitation
Pulmonary regurgitation

Mid-diastolic
Mitral stenosis
Tricuspid stenosis
Atrial myxoma

Continuous
Patent ductus arteriosus
Arteriovenous fistula

Pericardial friction rub

Pemeriksaan Fisik Back

Percuss and auscultate lung bases
Left ventricular failure
Pleural effusion

Sacral pitting oedema

Right heart failure

Pemeriksaan Fisik Abdomen

Patient lying with one pillow (if tolerated)

Tender hepatomegaly
Pulsatile liver (tricuspid regurgitation)
Ascites
Splenomegaly
Abdominal aortic aneurysm

Pemeriksaan Fisik Ekstremitas

Peripheral oedema
Pitting/non-pitting

Capillary return

Palpate arteries

Femoral
Popliteal
Posterior tibial
Dorsalis pedis
Buergers test
(peripheral vascular
disease)

Nadi Perifer

Dorsalis pedis pulse

Posterior tibial pulse

Kulit
Pallor
Cyanosis
Central
Peripheral

Warm/Cold

Nail
Clubbing

Nail
Splinter hemorrhages

Pemeriksaan Fisik Lain2

Urinalysis
Haematuria (infective
endocarditis)

Fundi
Hypertensive
retinopathy
Roth spots (infective
endocarditis)

Temperature chart
Infective endocarditis