EPC III Advanced Cardiovascular Exam

A physical examination focusing on potential cardiovascular issues.

A condition where cardiovascular problems are possible.

Inspection of hands and nails for color and pulse checks.

Evaluation of legs, feet, and hair distribution for potential issues.

Visual assessment of the jugular veins for signs of heart failure.

Adjusting listening positions during a heart exam for patients with significant heart issues or unusual heart sounds.

To feel for the point of maximal impulse (PMI) on the chest wall if there's a suspected displacement.

If a murmur (unusual heart sound) is heard, feeling the chest for a thrill.

Listen to the lungs at specific locations, front (4 areas), back (6 areas), and right armpit (1 area), usually with the patient sitting upright.

The patient should lie on their back for a general examination, if tolerated.

Listen for sounds from blood vessels in the abdomen.

Check for bluish discoloration of the skin due to low blood oxygen levels or other factors.

Collect patient history for factors that increase the risk of heart conditions, like diabetes, high blood pressure (HTN), and smoking.

Fluid accumulation in the tissues, causing a temporary indentation when pressed.

Indentation is 0 to 2 millimeters deep.

Indentation is 3 to 4 millimeters deep.

Indentation is 5 to 6 millimeters deep.

Indentation is 8 millimeters or deeper.

Listening to the carotid arteries for any abnormal sounds or bruits.

An abnormal sound heard over the carotid artery, indicating narrowed arteries.

Listening to the heart sounds using a stethoscope to identify normal sounds and any abnormalities.

Bluish discoloration of the skin, in the middle of the body, due to low blood oxygen.

Bluish discoloration of the skin in extremities due to increased oxygen extraction, not low blood oxygen.

Lack of pink color in the skin

Changes/abnormalities of the nails, specifically a change in the angle of the nail bed.

The angle between the nail plate and the nail bed.

Less than 160 degrees.

Conditions that include cyanotic congenital heart disease, infective endocarditis, chronic interstitial lung disease, and cystic fibrosis.

Inspecting fingers for clubbing; measuring nail bed angle.

The time it takes for blanched skin to return to its normal color after pressure is released, indicating blood flow to the capillaries.

A healthy capillary refill time is less than 2 seconds, indicating good blood circulation.

A capillary refill time of 2 seconds or more, suggesting potential issues with blood circulation.

Conditions like dehydration, heart failure, and shock can all cause a delayed capillary refill time.

Capillary refill is a quick and valuable indicator of overall circulatory health, especially in children.

Specific locations on the chest where you listen to heart sounds. These include the aortic, pulmonic, tricuspid, and mitral valves.

Assessing the speed and regularity of the heartbeat.

Additional sounds like S3 and S4, which can indicate certain heart conditions.

Abnormal heart sounds that can be caused by blood flowing through the heart in an unusual way.

Checking the strength and rhythm of the pulse in different areas of the body, such as the wrist and ankle.

Feeling the chest wall for abnormal vibrations or movements that can indicate heart problems.

A sustained, lifting motion of the chest wall that suggests right ventricular hypertrophy.