Cardiovascular System Examination

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.