CVS Examination done by Fahad Gadi 6 th year medical student-2007

1. CVS Examinationdone byFahadGadi 6thyear medical student-2007

2. CVS Examination • General • General appearance • The hands • The face • The neck • The praecordium • Inspection • Palpation • Auscultation

3. The praecordium • Inspection • Deformities • Apex beat • Visible pulsations • Scars • Palpation • Apex beat • Parasternal heave • Palpable thrills • Auscultation • Heart sounds • Added sounds • Cardiac murmurs

4. 1.General appearance Look for: • (ABCDE) • Respiratory distress • Cachexia • Dysmorphic features

5. 2.The Hands • Clubbing • Splinter hemorrhage • Osler nodes (tender) • Janway lesions (not tender)

7. 2.The Hands • Radial pulse: • Rate • Rhythm: [regular, irregular (irregularly irregular, regularly irregular)] • Character and volume (collapsing, alternans) • Radiofemoral delay • Radio-radial delay • Condition of the vessel wall • Blood pressure

8. 3.The Face • Jaundice • Xanthelasma • Mitral features (rosy cheeks, bluish tinge) • Central cyanosis in the tongue

10. 4.The Neck • Palpate the carotid artery medial to sternomastoid muscle for character (bisferience, collapsing, alternans, jerky) • Inspect the height of the JVP by inspecting the internal jugular vein

11. 4.The Neck • Jugular pulse can be distinguished from arterial pulse by: • It is a complex wave (flicker twice) • Jugular is visible but not palpable • JVP decreases with inspiration • It is filled from above after removing pressure applied to the base of the neck

13. 5.The Praecordium By INSPECTION: • Scars • Skeletal abnormalities (pectus excavatum, kyphoscoliosis) • Apex beat • Other visible pulsations

15. 5.The Praecordium By PALPATION: • Apex beat: • Site (the most lateral and most inferior; normally in the 5th left intercostals space in the mid clavicular line) • Displaced or not • Character (heaving, double impulse, tapping) • Parasternal impulse: By the heel of the hand rested just to the left of the sternum. • Palpable murmurs (thrills): Start at the apex then the left sternal edge then the base of the heart.

16. 5.The Praecordium: By AUSCULTATION: • Start in the mitral area with the bell to hear low pitch sounds like in mitral stenosis then use the diaphragm. • Then move to the tricuspid area (5th Lt. intercostal) • Then to pulmonary area (2nd Lt. intercostal) • Then to aortic area (2nd Rt. intercostal) • On auscultation listen to: • Heart sounds (S1, S2) • Abnormalities in heart sounds (loud, soft, increased splitting, fixed splitting, reversed splitting) • Additional sounds (S3, S4) • Heart murmurs

18. What to look for in Murmers • Site • Intensity ( 6 grades ) • Time • Duration • Radiation • Special caracter

19. 6.The Back Percussion and auscultation of the lung bases looking for signs of cardiac failure like: • Crepitation • Pleural effusion • Sacral edema

20. 7.The Abdomen Look for • Ascitis • Hepatomegaly

21. 8.The Lower limbs • Palpate the • Femoral artery (below inguinal ligament 1/3 of the way up from the pubic tubercle) • Popliteal artery (behind the knees) • Post. tibial (below medial malleolus half the way between the calcaneus and medial malleolus) • Dorsalis pedis (between the 1st and 2nd metatarsal bone lateral to flexor hallosis longus) • Then look for lower limb edema.

23. THANK YOU