1 / 103

CARDIOVASCULAR EXAMINATION

CARDIOVASCULAR EXAMINATION. Assoc Prof Elif Eroğlu Büyüköner October 2013. EXAMINATION of the CARDIOVASCULAR SYSTEM. General inspection Specific inspection Pulse Carotid Neck veins Praecordium Auscultation Lung bases,liver, ankles Veins and arteries in the legs. GENERAL INSPECTION.

kaemon
Download Presentation

CARDIOVASCULAR EXAMINATION

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CARDIOVASCULAR EXAMINATION AssocProf Elif Eroğlu Büyüköner October 2013

  2. EXAMINATION of the CARDIOVASCULAR SYSTEM • General inspection • Specific inspection • Pulse • Carotid • Neck veins • Praecordium • Auscultation • Lung bases,liver, ankles • Veins and arteries in the legs

  3. GENERAL INSPECTION • General build and appearence • Colour • Respiration (abnormal breathing pattern, shortness of breath) • Signs of distress and response • Conscious level

  4. Myxoedema

  5. Hyperthyroidism

  6. Mitral Facies / Facies Mitralis

  7. Ear Lobe Crease

  8. Down Syndrome

  9. Moonface

  10. Acromegaly

  11. SPECIFIC INSPECTION • Cyanosis • Central: mucous membranes-tongue • Peripheral: extremities • Clubbing • Anemia • Edema • Peripheral perfusion • Body habitus • Specific signs of cardiac pathologies: IE stigmata, arcus senilis, xanthome and xanthelasma

  12. CYANOSIS and CLUBBING

  13. Central Cyanosis

  14. Peripheral Cyanosis

  15. Icterus

  16. Petechiae

  17. ErythemaMarginatum

  18. Signs of atherosclerosis Xanthelesma Arcusjuvenilis Signof prematureatherosclerosis xanthoma

  19. Xantoma

  20. IE/specificsigns

  21. Body habitus: Marfansyndrome, thoraxabnormalities

  22. The PULSE • Rate • Normal sinus 60-100bpm • Sinus bradycardia <60 bpm • Sinus tachycardia >100 bpm • Regularity • Sinus arrhytmia: varies with respiration • Intermittant irregularity: ectopic beats • Continously irregular: atrial fibrillation

  23. Carotid examination • Carotid upstroke • Brisk/normal/delayed • Volume:increased/normal/decreased • Anacrotic/bisferiens • Carotid auscultation • Bruit • Transmitted murmur • A2 audible in the neck

  24. Carotid pulse contour • A. Hyperkinetic:AR • B.Bisferiens: AS/AR • C.Bifid: IHSS • D.Hypokinetic/alternans: LVD • E.Parvus et tardus: AS

  25. BLOOD PRESSURE MEASUREMENT

  26. Recommended technique for BP measurement

  27. Juguler venous pulse

  28. Patient position for JVP assessment

  29. JVP measurement

  30. Jugular Venous Pressure Waveform

  31. a wave - atrial systole x descent – onset of atrial relaxation c wave - small positive notch in the 'x' descent due to bulging of the AV ring into the atria in ventricular contraction. x' (prime) descent !!! occurs during systole due to RV contraction pulling down the TV valve ring “descent of the base” a measure of RV contractility v wave - after the x' descent - slow positive wave due to right atrial filling from venous return y descent - rapid emptying of the RA into RV due to TV opening Normal JVP waves and descents

  32. Abnormal “a” wave • AV valve obstruction: TS, RA myxoma • Decreased RV compliance:RVH, PS, PHT • AV dysassociation:AV blocks, “Cannon” a waves • Severe HCM: Bernheim effect • No visible “a” wave in AF

  33. X’ descent • Beginning of the RA diastole, before venous filling to the RA, during RV systole. RVFW moves to the septum, TV moves to the apex and RA base is pulled down (RA pressure falls) • More prominent during inspiration • Increases with RV contractility:tamponade • RV volume inc: ASD, VSD • RV pressure inc: PD, PHT • Decreases in RV contractility: reduced x’

  34. v wave • RA filling, together with S2 • Severe TR: CV fusion, no X’ descent y descent • RV filling (early diastole) • Inc: TR, CP, RCM • Dec: Tamponade, TS

  35. Apical Impulse: • Visualization to assess ventricular size/thickness • Normally distinct and located at 4ICS at/inside the midclavicular line

  36. Apical Impulse (abnormal): • Hyperdynamic impulse in normal location: think increased cardiac output or LVH • Hyperdynamic and downward/leftwardly displaced: think LVE • Indistinct impulse associated with RVH • Precordial heave is seen with RVE

  37. Thrills: • Palpation of a loud murmur • Found in the precordial, suprasternal, or carotid artery area • If low intensity murmur, probably just a pulsation and NOT a thrill

  38. Auscultation

  39. Heart Sounds

  40. S1 (cont.): • If split heard better at the apex, may actually be S4 or ejection click • Tends to be more low-pitched and long as compared to S2 • Differentiate S1 from S2 by palpating carotid pulse: • S1 comes before and S2 comes after carotid upstroke

  41. Decreased S1: • Slowed ventricular ejection rate/volume • Mitral insufficiency • Increased chest wall thickness • Pericardial effusion • Hypothyroidism • Cardiomyopathy • LBBB • Shock • Aortic insufficiency • First degree AV block

  42. Other Abnormal S1 (cont.): • Increased S1: • Increased cardiac output • Increased A-V valve flow velocity (mitralstenosis)

  43. S2: • From closure vibrations of aortic and pulmonary valves • Divided into A2 and P2 (aortic and pulmonary closure sounds) • Best heard at LMSB/2LICS • Higher pitched than S1/better heard with diaphragm

  44. S2 splitting (normal): • Normally split due to different impedance of systemic and pulmonary vascular beds • Audible split with > 20 msec difference • Split in 2/3 of newborns by 16 hrs. of age, 80% by 48 hours • Harder to discern in heart rates > 100 bpm

More Related