Cardiac Examination Techniques Quiz 1

Cardiac Examination Techniques and Tips

• The left ventricular outflow tract can be brought closer to the chest wall by having the patient sit up, lean forward, and exhale to improve the detection of aortic regurgitation.
• The diaphragm of the stethoscope is better for picking up high-pitched sounds like S1, S2, aortic and mitral regurgitation, and pericardial friction rubs, while the bell is more sensitive to low-pitched sounds like S3, S4, and the murmur of mitral stenosis.
• To palpate heaves, use your palm and/or hold your fingerpads flat or obliquely against the chest.
• For thrills, press the ball of your hand firmly on the chest to check for a buzzing or vibratory sensation caused by underlying turbulent flow.
• S1 and S2 are usually not palpable, but palpable S3 and S4 can be identified by positioning the patient in the left lateral decubitus position and palpating the cardiac apex gently as the patient exhales and briefly stops breathing.
• The apical impulse is usually the PMI and can be located by asking the patient to exhale fully and stop breathing for a few seconds.
• Palpate for the systolic impulse of the right ventricle with the patient supine and the head elevated to 30°, and assess its location, amplitude, and duration to identify various conditions.
• In obstructive pulmonary disease, hyperinflation of the lungs may prevent palpation of the hypertrophied right ventricle in the left parasternal area.
• The pulmonary artery area overlies the pulmonary artery, and a prominent pulsation here often accompanies dilatation or increased flow in the pulmonary artery.
• The aortic outflow tract area overlies the aortic outflow tract, and a pulsation in this area suggests a dilated or aneurysmal aorta.
• Carotid pulse examination provides valuable information about cardiac function, especially in aortic valve stenosis and regurgitation, and should be performed with caution to avoid decreasing blood flow to the brain or inducing syncope.
• Landmarks and the Valsalva maneuver can be used to enhance the cardiac examination.

Clinical Bedside Examination

• Systolic blood pressure response follows four phases: transient increase, sharp decrease, acute drop, and "overshoot" increased blood pressure
• Method to evaluate jugular venous pressure (JVP) involves measuring the vertical distance in centimeters above the sternal angle where the horizontal object crosses the ruler and adding 5 cm
• Breast development typically begins by age 12, and males can also get breast cancer
• Carotid artery palpation should be done cautiously to prevent dislodgment of atherosclerotic plaque, which could lead to stroke
• Jugular venous pulsations (JVP) are usually evident in euvolemic patients and an elevated JVP is correlated with acute and chronic heart failure, tricuspid stenosis, chronic pulmonary hypertension, and other conditions
• Comprehensive cardiovascular exam includes assessment for breast changes, abnormal lymph nodes, and conditions like impaired cardiac output, pericarditis, infective endocarditis, myocarditis, valvular disorders, and cardiomyopathy
• Different types of pulses such as a left-sided S4, bisferiens pulse, and paradoxical pulse indicate specific cardiac conditions
• Electrical alterations like dysrhythmias (bradycardia, tachycardia, atrial fibrillation, atrial flutter) and irregular ventricular rhythm should be assessed
• Heart sounds should be evaluated for variations in intensity
• Spleen located in the left upper quadrant (LUQ) can cause LUQ pain and swelling if inflamed
• Abnormal lymph nodes should be assessed for characteristics like fixed, hard, asymmetric, and swelling, while normal lymph nodes are soft, movable, and symmetric
• Lymphadenopathy should be distinguished between local and generalized, with cervical lymph node swelling being the most common. Supraclavicular swelling requires further investigation.