cardiovascular exam

cardiovascular exam

cardiovascular exam

CARDIAC EXAMINATION It is performed as a part of physical examination. At the bedside, it makes sense to have a rough sheet written with all information that needs to be collected while working up a patient. Cardiovascular assessment will help to identify significant factors that can influence cardiovascular health

HISTORY SHEET:

A patient history sheet should contain patient personal details which include Name, Address, Age, Sex, Date of admission and Examination, Present complaints of the patient, History of patient, Congenital Heart Disease, Patient risk factors: Diabetes, Hypertension, Smoking, Alcoholism, family history, personnel history

GENERAL EXAMINATION:

The general examination is actually the first step of physical examination.

Instruments and Equipment:Stethescope,Thermomanometer,Sphigmomanometer,Torch.

We have to check whether the patient is conscious and cooperative; symptomatic at rest. The general examination includes the examination of general appearance(height, weight, BMI, Level of consciousness, facial feature, speech), Hands and arms, Skin and its appendages, Face, Eyes, Mouth, Neck, Oedema, Thickened nerves, Lymphadenopathy, Vertebral column, Pallor, Cyanosis, Decubitus, Vital signs

Nutrition: To look for

Protein deficiency: Rough skin, oedema, Ascites

fat: Loss of subcutaneous fat

vitamin deficiencies: Look for vitamin A, C, D, Vitamin B 12, Niacin, Thiamin, Riboflavin,

Carbohydrate deficiencies are not seen clinically

CARDIOVASCULAR EXAMINATION:

Jugular venous pressure: It reflects pressure in the atrium. Visualise the jugular venous pulse between the sternal and clavicular heads of the sternocleidomastoid. Exam the respiratory variation, pressure, wave pattern. A jugular venous pressure can be seen in hypovolemia and elevated jugular venous pressure can be seen in right ventricular infarction, Myocardial infarction, Valvular heart disease, Cardiomyopathy and left heart failure due to the intravascular volume overload. Kussmaul sign is the failure of decline JVP during inspiration

Carotid Pulses: Palpate carotid pulse one at a time and we have to assess the character of pulse.Auscultate the carotid arteries for the presence of a bruit

 

Precordial Examination:

Inspection: look for the shape and size of the chest(eg: pectus carinatum, pectus excavatum), Presence of any asymmetry, Apex beat, Respiratory movements, Presence of any asymmetry, Parasternal pulsation, Suprasternal, epigastric pulsation

Auscultation: Auscultation can be defined as the process of listening with a stethoscope. Heart sounds: S1, S2, S3, S4, look for other sounds include systolic click, systolic honk. Listen for a pericardial rub, Listen for murmurs(systolic murmur, diastolic murmur, continuous murmur)

In the interscapular area: the murmur of coarctation of the aorta can be identified,For collateral murmurs, pulmonary arteriovenous fistula. Auscultating the left first intercostals space will help to identify the patent ductus arteriosus. From right first space and neck supra valvular aortic stenosis can be identified

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