CVS Examination

done byFahad Gadi

6th year medical student-2007

CVS ExaminationGeneral

General appearance The hands The face The neck

The praecordium Inspection Palpation Auscultation

The praecordiumInspection

Deformities Apex beat Visible pulsations Scars

Palpation Apex beat Parasternal heave Palpable thrills

Auscultation Heart sounds Added sounds Cardiac murmurs

1.General appearance

Look for:

(ABCDE) Respiratory distress Cachexia Dysmorphic features

2.The Hands Clubbing Splinter hemorrhage Osler nodes (tender) Janway lesions (not tender)

2.The HandsRadial pulse:

RateRhythm: [regular, irregular (irregularly irregular,

regularly irregular)]Character and volume (collapsing, alternans)Radiofemoral delayRadio-radial delay

Condition of the vessel wallBlood pressure

3.The Face

Jaundice Xanthelasma Mitral features (rosy cheeks, bluish tinge) Central cyanosis in the tongue

4.The Neck

Palpate the carotid artery medial to sternomastoid muscle for character (bisferience, collapsing, alternans, jerky)

Inspect the height of the JVP by inspecting the internal jugular vein

4.The Neck

Jugular pulse can be distinguished from arterial pulse by:It is a complex wave (flicker twice)Jugular is visible but not palpableJVP decreases with inspirationIt is filled from above after removing pressure applied

to the base of the neck

5.The Praecordium

By INSPECTION: Scars Skeletal abnormalities (pectus excavatum,

kyphoscoliosis) Apex beat Other visible pulsations

5.The Praecordium

By PALPATION: Apex beat:

Site (the most lateral and most inferior; normally in the 5th left intercostals space in the mid clavicular line)

Displaced or not Character (heaving, double impulse, tapping)

Parasternal impulse: By the heel of the hand rested just to the left of the sternum.

Palpable murmurs (thrills): Start at the apex then the left sternal edge then the base of the heart.

5.The Praecordium:

By AUSCULTATION:Start in the mitral area with the bell to hear low pitch

sounds like in mitral stenosis then use the diaphragm.Then move to the tricuspid area (5th Lt. intercostal)Then to pulmonary area (2nd Lt. intercostal)Then to aortic area (2nd Rt. intercostal)On auscultation listen to:

Heart sounds (S1, S2)Abnormalities in heart sounds (loud, soft, increased splitting, fixed

splitting, reversed splitting)Additional sounds (S3, S4)Heart murmurs

What to look for in Murmers

• Site• Intensity ( 6 grades )• Time• Duration• Radiation• Special caracter

6.The Back

Percussion and auscultation of the lung bases looking for signs of cardiac failure like:

Crepitation Pleural effusion Sacral edema

7.The Abdomen

Look for Ascitis Hepatomegaly

8.The Lower limbs Palpate the

Femoral artery (below inguinal ligament 1/3 of the way up from the pubic tubercle)

Popliteal artery (behind the knees) Post. tibial (below medial malleolus half the way

between the calcaneus and medial malleolus) Dorsalis pedis (between the 1st and 2nd metatarsal

bone lateral to flexor hallosis longus) Then look for lower limb edema.

THANK YOU