Cardiovascular System Examination

Study Notes

Cardiovascular Exam

A comprehensive cardiovascular exam includes an appropriate history, vital signs, and assessment of distal vasculature.
Vital signs include blood pressure, pulse rate, rhythm, and volume.

Importance of Appropriate Technique

A good examiner should be respectful and considerate of the patient's modesty.
Expose only the necessary amount of skin and use "artful" draping to minimize discomfort.
Explain the exam procedure to the patient and enlist their assistance when needed.
Avoid rushing the exam and don't examine body parts through the gown.

Observation

Pay attention to chest shape, shortness of breath, and visible impulses on the chest wall.
Note if the patient is sitting upright or able to speak.

Surface Anatomy

Find the sternal manubrium junction (angle of Louis) to identify valve areas.
Valves and surface anatomy are correlated, and the area of auscultation determines what you hear.

Palpation Technique

Use fingers across the chest, under the breast, and explain the procedure to the patient.
Identify the point of maximal impulse (PMI) at the apex of the ventricle.
Palpate the left ventricle to determine its size and vigor of contraction.
Rarely, a palpable thrill may be present, associated with regurgitant or stenotic murmurs.

Palpation of Right Ventricle

Palpate the right ventricle to assess its vigor of contractility.
Use the heel of the right hand along the sternum to palpate the right ventricle.

Auscultation

Use a stethoscope to listen for normal valve closure sounds.
Identify the first heart sound (S1) as the closure of the mitral and tricuspid valves.
Identify the second heart sound (S2) as the closure of the pulmonic and aortic valves.
Note the time between S1 and S2 (systole) and between S2 and S1 (diastole).

Auscultation Technique

Have the patient lie at a 30-45 degree incline with the chest exposed.
Use the stethoscope with the diaphragm engaged to hear higher pitched sounds.
Start auscultation over the aortic area (2nd right intercostal space) and move to the pulmonic area (2nd left intercostal space).

Examining Female Patients

Follow the same technique as for male patients, with adjustments for the female patient's anatomy.
Ask the patient to remove their bra or work around it to examine the heart and lungs.
Enlist the patient's assistance to position their breasts for the exam.

Description

This quiz covers the components of a cardiovascular system examination, including taking a patient's history, vital signs, and assessment of distal vasculature. It also discusses the importance of respectfully touching patients and managing sources of tension during the exam.