1.

Introduction
- Nama, Gelar
- Minta identitas pasien
- Apa yang akan dilakukan pada pasien
o Checking for pulse (Carotid and Brachialis)
o Listening to the heart noise
2. Informed Consent
3. Ask for existing pain and questions before beginning examination
4. WASH YOUR HANDS!
5. General Examination:
o Shortness of Breath
o Cyanosis
o Pallor
o Oedema
6. Inspect Hands (Back of the hands)
o Peripheral Cyanosis
 Congenital (?) (Congestive?) Heart Disease / Heart Failure
o Splinter Haemorrhages
 Infective Endocarditis
7. Inspect Hands (Palms)
o Xanthoma(ta)
 Hypercholesterolemia
o Osler’s Nodes & Janeway Lesions
 Infective Endocarditis
o Tar Staining
 Smoking
8. Clubbing Fingers (Infective Endocarditis & Congenital (?) (Congestive?) Heart
Disease / Heart Failure
9. Assess Temperature of the Arms
a. Touch patient’s arm with the back of your fingers;
 By the Cubital Fossa
 Before the wrist
 On the Wrist and Back of the hand
10. Capillary Refill Time
o Before 2 Seconds is normal
11. Palpate Radial Pulse
o Assess Rate & Rhythm
12. Assess for Radio-Radial Delay (Feel both radial pulses at the same time)
o Aortic Coarctation (Narrowing of the Aorta)
 If present, a delay between bilateral radial pulses suggests
narrowing of the aorta proximal to the left subclavian artery -
classically in the context of coarctation of the aorta.
 Left radial pulse is slightly later than the right
13. Assess for a Collapsing Pulse
o Aortic Regurgitation
 Watson's water hammer pulse, also known as
Corrigan's pulse or collapsing pulse, is the medical sign
(seen in aortic regurgitation) which describes a pulse that is
bounding and forceful, rapidly increasing and
subsequently collapsing, as if it were the sound of a
waterhammer that was causing the pulse.
14. Palpate Brachial Pulse
15. Auscultate the Carotid Arteries
a. Ask Patient to HOLD their breath
b. Place BELL of stethoscope on the patient’s carotid artery
o Detect bruits
16. IF NO BRUITS, Palpate the Carotid Arteries
17. Assess Jugular Venous Pressure
a. Patient turning head at 45 degree angle
b. Located between the two heads of the sternocleidomastoid
i. RAISED IN HEART FAILURE
18. Assess Hepatojugular Reflux
i. Apply Pressure to the liver
ii. Observe for a rise in JVP (Jugular Venous Pressure)
 POSITIVE = SUSTAINED RAISED > 4 cm > Gagal Jantung
Kanan
19. Inspect the Eyes
a. Xanthelasma
o Hyperlipidemia
b. Corneal Arcus
o Hyperlipidemia
20. Conjunctival Pallor (PULL DOWN EYE-LID)
o Anemia
21. Inspect the Mouth (OPEN THE MOUTH THEN ASK PATIENT TO TOUCH ROOF
OF MOUTH WITH THE TONGUE)
- Angular stomatitis
- Central cyanosis
- Dental Hygiene
- High Arched Palate
22. Inspect the Chest
- Chest Wall Deformities
- Scars:
o Central Chest – Sternotomy/Thoracotomy
o Clavicular – Pacemaker
o Left Mid-Axillary Line – Subcutaneous(S-) ICD (Implantable
Cardioverter-Defibrillator)
o LIFT ARMS (Lateral Thoracotomy)
23. Palpate Apex Beat
o 5th Intercostal Space in the Mid-Clavicular Line

24. Assess for a Parasternal Heave

- Right Ventricular Hypertrophy
25. Assess for Thrills across all four valves
- Thrills are Palpable Murmurs
26. Auscultate Each of the Heart Valves
aorta pulmonal membran
mitral tricuspid bell
- WHILST PALPATING THE CAROTID PULSE
- Katup mitral (BELL): ICS 5, garis midclavicula sinistra
- Katup tricuspid (BELL): ICS 4, di kiri bawah ujung sternum
- Katup pulmoner (MEMBRAN): ICS 2, ujung kiri sternum
- Katup aorta (MEMBRAN): ICS 2, ujung kanan sternum
- Auskultasi nadi karotis. Bila ada murmur, bisa jadi ada stenosis aorta
27. Accentuation maneuver saat ada aortic murmur, yaitu pasien disuruh duduk tegak,
tarik napas. Murmur akan terdengar jelas saat ekspirasi
28. Accentuation maneuver saat ada mitral murmur, pasien disuruh baring ke arah kiri,
terdengar jelas saat ekspirasi, lanjutkan auskultasi ke axilla untuk mendengarkan
radiation of a mitral murmur
- Punggung
- Auskultasi paru untuk deteksi edema pulmo
- Kiri kanan bawah lateral punggung terdengar coarse crackle : edema pulmo
karena gagal jantung kiri
- Palpasi punggung bawah (boyok) untuk edema sacralis kanan kiri
- Kaki
- Periksa edema pada pergelangan kaki : gagal jantung kanan
- Penutup
- Terima kasih
- Cuci tangan
- Kesimpulan
Checklist Tramed Jantung
• Pendahuluan
⁃ Perkenalan
⁃ Cuci tangan
⁃ Konfirmasi identitas
⁃ Penjelasan mengenai pemeriksaan
⁃ Informed consent
• Dari ujung kasur
⁃ Sesak napas
⁃ Cyanosis
⁃ Palor
 ⁃ Edema
• Tangan
⁃ Peripheral cyanosis : CHD/HF
⁃ Splinter haemorrhage : infective endocarditis
⁃ Xanthomata : hypercholesterolemia
⁃ Osler’s nodes & janeway lesions : infective endocarditis
⁃ Tar staining : smoking
⁃ Tes clubbing finger : dengan mendekatkan buku kedua jari telunjuk, harusnya
ada jarak (normal), kalau clubbing finger tidak ada jarak
⁃ Suhu tangan (dari lengan)
⁃ Capillary refill time (<2detik)
⁃ Palpasi arteri radialis (rate & rhythm)
⁃ Palpasi pulsasi arteri radialis kanan kiri supaya mengetahui radio radial delay
(aortic coarctation)
⁃ Angkat tangan pasien sambil periksa arteri radialis apakah pulsasi menghilang
supaya mengetahui regurgitasi aorta
⁃ Palpasi arteri brachialis
⁃ Auskultasi arteri karotis untuk periksa ada bruits (tahan napas, pake bell)
⁃ Palpasi arteri karotis jika tidak ada bruits
• Tekanan vena jugularis
⁃ Pasien hadap ke kiri (45°)
⁃ Vena jugularis terletak diantara 2 caput m. Scm (kalo naik mengindikasikan
gagal jantung kanan)
⁃ Periksa refleks hepatojugular dengan menekan abdomen di hepar, periksa jika
terjadi kenaikan tekanan vena jugularis (jika positif, naiknya bisa lebih dari sama dengan
4cm)
• Mata (inspeksi)
⁃ Xanthalesma : hyperlipidemia
⁃ Corneal arcus : hyperlipidemia
⁃ Konjungtiva pucat : anemia
• Mulut (inspeksi)
⁃ Buka mulut, angkat lidah
 ⁃ Angular stomatitis
⁃ Central cyanosis
⁃ Dental hygiene
⁃ Highly arched palate
• Dada
⁃ Deformitas
⁃ Luka (central chest : sternotomy/thoracotomy, clavicular : pacemaker, left
midaxillary line : subcutaneous ICD)
⁃ Angkat tangan : lateral thoracotomy
⁃ Pulsasi apex cordis : ICS 5 di garis midclavicula sinistra
⁃ Periksa di apex cordis jika ada parasternal heave : hipertrofi bilik kanan
⁃ Periksa thrills di 4 katup jantung (murmur yang terasa di palpasi)
⁃ Auskultasi masing2 katup jantung sambil palpasi nadi karotis (pertama dengan
membran, kedua dengan bell).
⁃ Katup mitral : ICS 5, garis midclavicula sinistra
⁃ Katup trikuspid : ICS 4, di kiri bawah ujung sternum
⁃ Katup pulmoner : ICS 2, ujung kiri sternum
⁃ Katup aorta : ICS 2, ujung kanan sternum
⁃ Auskultasi nadi karotis. Bila ada murmur, bisa jadi ada stenosis aorta
⁃ Accentuation maneuver saat ada aortic murmur, yaitu pasien disuruh duduk
tegak, tarik napas. Murmur akan terdengar jelas saat ekspirasi
⁃ Accentuation maneuver saat ada mitral murmur, pasien disuruh baring ke arah
kiri, terdengar jelas saat ekspirasi, lanjutkan auskultasi ke axilla untuk mendengarkan
radiation of a mitral murmur
• Punggung
⁃ Auskultasi paru untuk deteksi edema pulmo
⁃ Kiri kanan bawah lateral punggung terdengar coarse crackle : edema pulmo
karena gagal jantung kiri
⁃ Palpasi punggung bawah (boyok) untuk edema sacralis kanan kiri
• Kaki
⁃ Periksa edema pada pergelangan kaki : gagal jantung kanan
• Penutup
⁃ Terima kasih
⁃ Cuci tangan
⁃ Kesimpulan