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Examination of the Cardiovascular System

Examination of the Cardiovascular System

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Published by kenners

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Published by: kenners on Mar 27, 2007
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07/21/2014

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James Wight
Examination of the Cardiovascular System
• Wash your hands.• Introduce yourself to the patient, and ask permission to examine them.• Expose the patient, and position them at 45°.
Inspection
Look around the bedGTN spray (IHD), oxygen mask/nasal prongs, drips (eg IE), cigarettesLook at the patientComfortable at rest, cyanosis, breathless, scars (eg midline sternotomyfor CABG, left axillary scar for mitral valve replacement), pacemaker boxes, syndromes (Marfan’s, Down’s, Turner’s), cachexiaLook at the handsClubbing (congenital cyanotic heart disease, IE, atrial myxoma), splintehaemorrhages (IE), Osler’s nodes (IE), capillary refill time, peripheralcyanosis, nicotine staining, pale palmar creases (anaemia), Janewaylesions (IE), tendon xanthomata (hypercholesterolaemia).Feel the radial pulseAssess rate (over 15s) and rhythm (sinus, regularly irregular or irregularlyirregular), assess for radioradial delay (coarctation of the aorta)Check for collapsing pulseFound in ARFeel the brachial pulseAssess character (slow rising, bounding, pulsus arterans, pulsusbisferiens) and ask for blood pressure (wide splitting, narrow splitting,pulsus pardoxus)Look at the faceLook for signs of pain (IHD), Cushings (possible HT), malar flush (mitralstenosis).Look at the eyesXanthelasma, corneal arcus, anaemia, ophthalmoscopy (looking for Rothspots and hypertensive retinopathy)Look in the mouthHigh arch palate (Marfans), central cyanosis, telangiectasiaLook at the neckAssess the jugular venous pressure, feel the carotid pulse
Palpation
Feel for the apex beatUsually in the 5
th
intercostal space in the midclavicular line. The angle of Louis marks the 2
nd
intercostal space.Feel for thrills and heavesUse a Z-shaped pattern for examination
Percussion
Unnecessary in the CVS examination (except lung bases, see later)
Auscultation
Simultaneously listen and palpate a pulse (preferably a central pulse) to time any murmur to the cardiaccycle.Listen over the apex beat (mitral area) with the bell,and then diaphragmListen for heart sounds 1 and 2 (and 3 and 4),systolic and diastolic murmurs.Listen at the left sternal edge in the 4
th
intercostalspace (tricuspid area)Listen for heart sounds 1 and 2, systolic and diastolicmurmurs.Listen at the left sternal edge in the 2
nd
intercostalspace (pulmonary area)Listen for heart sounds 1 and 2, systolic and diastolicmurmurs.Listen at the right sternal edge in the 2
nd
intercostal Listen for heart sounds 1 and 2, systolic and diastolic

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Aung Cho liked this
Jide Oloyede added this note
Nice one. Could you please come up with another one on standard way of reporting one's findings.
Charly Neal liked this
Abdurhman HA added this note
nice

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