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Cardiovascular Examination. Dr. Aisha AL-Ghamdi Associate professor Consultant internist. Cardiovascular Examination. General examination. Heart examination . Cont. Blood pressure (supine & erect, why?). Signs of heart failure in other organs (lungs, liver, lower limbs )

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Cardiovascular Examination

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Cardiovascular Examination

Dr. Aisha AL-Ghamdi

Associate professor

Consultant internist


Cardiovascular Examination

  • General examination.

  • Heart examination.


Cont.

  • Blood pressure (supine & erect, why?).

  • Signs of heart failure in other organs (lungs, liver, lower limbs )

  • Fundus examination (arterial changes, haemorrhages, exudates and papilloedema) in arterial hypertension.


Radial arterial puls.

  • Rate: average =70/min (range,60-90). increased & decreased in some conditions what are they ?

  • Rhythm.

  • Form of pulse wave.

  • Volume.

  • Vessel wall.

  • Synchronicity with other radial artery delay?

  • Radio femoral delay (aortic coarctation).


Jagular venous pressure(JVP).

  • Position of the patient at (45), head.

  • Features of JVP, how to differentiate with carotid pulsation in the neck.

  • Hepato-jugular reflex’ .

  • Waves (a, c, x, v, y)


Heart examination;

  • Inspection :

  • Apex beat .

  • left parasternal movement due to right ventricular hypertrophy.

  • pulsation in 2d left ICS 2ry to enlarged PA.

  • epigastric pulsation 2ry to expanded abdominal aorta


Cont. heart exam.

  • Palpation :

  • Apex beat 5th ICS midclavicular line.

  • Left parasternal heave 2nd ICS 2ry to RVH.

  • Thrill (vibrating sensation indicates palpable murmur).


Cont. heart exam.

  • Auscultation:

  • bell to detect low-pitched sounds , press lightly against the skin

  • diaphragm detect high-pitched sounds

    press firmly against the skin


Cont. auscultation

  • Normally audible heart sounds:

    1st & 2nd HS

  • Added sounds: 3rd & 4th HS, pericardial friction rub (pericarditis), opening snap (m.s), mitral click(m.v.p)

  • murmers


Murmurs

  • Turbulent blood flow caused by diseased valve or if a large amount of blood flows through a normal valve.

  • characteristics of murmurs suggest the cause of it (site, radiation, pitch, timing and the intensity) .


Cont.

  • Site; area over which a murmur is best heared depends upon the valve of origin and the direction of the blood flow. (Mitral m.at apex, aortic m.at right 2nd ICS)

  • Radiation; occurs along line of blood flow. (AS» neck, AR» left sternal edge.)


Cont.

  • Pitch; the greater the pressure gradient the higher the pitch(MS m.» low-pitched, AR m.» high-pitched)

  • Timing; in relation to the1st and the 2nd HS

    Systolic; time between 1st and the 2nd HS, could be mid-systolic (AS), pansystolic (MR).

    Diastolic; time between 2nd and the 1st HS, can be divided into three phases. Early (AR), Mid-diastole (MS), Presystole.


Cont.

  • Examples of murmurs;

    Systolic; MR,TR, AS, PS.

    Diastolic; MS,TS, AR, PS.

    Continuous; PDA.


Signs of cardiac failure:

  • Elevation of the JVP.

  • Gallop rhythm (tachycardia and 3rd HS).

  • Basal crepitations.

  • Hepatomegaly.

  • Dependent pitting oedema.


Examination of peripheral arteries:

  • All pulses should be examined . What are they ??

  • Look for bruit (indicates arterial stenosis)

  • Look for signs of arterial insufficiency. 5Ps Pain, Pallor, Pulselessness, Paresthesias, ,Paralysis. (Pain is the earliest sign) are the signs of acute leg ischemia.


Examination of peripheral veins:

  • inflammation or thrombosis of a vein may cause local discomfort or pain.

  • Manifestations of venous obstruction depends on site, extent and adequacy of collateral vessels

  • Cyanosis and oedema are signs of venous obstruction.


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