CVS
Inspection:
- Assessment and general comment on larger visible veins
- Check for vital sign - look for any signs of cvs signs such as (Hands; (such as Clubbing, peripheral cyanosis, rash, ((effective endocarditis signs cc?)), tremor )
- Comment on pulse (femero-radial etc…)
- Pulse radial, put hands on midline of forearm - then raise above head level - (determines blood volume) (((collapsing pulse)))
- Jaundice, cyanosis face examination
- Check for any scars or visible pulsation
Palpation:
- At nipple line mostly - intercostals th - you can determine it by counting it
- medial to mid clavicular line
- best to palpate by tip of finger, better if patient swirvs to opposite side
left parasternal heap; pulmonary hypertention,
Valves locations:
- Mitral valve fifth left intercostal midclavicular
- Tri - 4th intercostal parasternal
- Pulmonary - 2nd intercostal parasternal
- Aortic - 1st RIGHT intercostal parasternal
To check for thrill - we use two-three fingers by palm gently placing them on valves locations
Auscultation:
- 45 degree position
- Use your fingers to find the location, or estimation by nipple line by placing your finger to localize the intercostal space, rather than auscultating directly
- Assess for Radial/Carotid artery for synchonirization
- auscultate by bell first then diaphragm only for mitral - then switch for the diaphragm for mitral - rest is for diaphragm
- start from mitral - tri - pulm - aortic
- comment on murmur presecence, comment if its audible or if theres any added sounds - may comment as s1 s2, or 1st 2nd heart sound
Percussion: Is limited - cardiomegaly, pericardial effusion,
check for ascites, edema, etc… for general cvs dysfunction
Jugular venous pressure measurement
- normal below 3 cm
- 45 degree, ask patient to look other side
- observe the jugular vein check for any visible pulsation; you may use lighting
- use two measurement on at sternal angle and other by height of pulse
- jugular venous reflux - hepato-jugular
deep palpation of liver