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Cardiovascular Examination

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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  1. Cardiovascular Examination Dr. Aisha AL-Ghamdi Associate professor Consultant internist

  2. Cardiovascular Examination • General examination. • Heart examination.

  3. 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.

  4. 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).

  5. 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)

  6. 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

  7. Cont. heart exam. • Palpation : • Apex beat 5th ICS midclavicular line. • Left parasternal heave 2nd ICS 2ry to RVH. • Thrill (vibrating sensation indicates palpable murmur).

  8. 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

  9. 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

  10. 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) .

  11. 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.)

  12. 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.

  13. Cont. • Examples of murmurs; Systolic; MR,TR, AS, PS. Diastolic; MS,TS, AR, PS. Continuous; PDA.

  14. Signs of cardiac failure: • Elevation of the JVP. • Gallop rhythm (tachycardia and 3rd HS). • Basal crepitations. • Hepatomegaly. • Dependent pitting oedema.

  15. 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.

  16. 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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