Cardio Vascular System Examination

Cardiovascular System Examination

• Presented By – • Prof.Dr.R.R.Deshpande (M.D

in Ayurvdic Medicine & M.D. in Ayurvedic Physiology)

• www.ayurvedicfriend.com• Mobile – 922 68 10 630• professordeshpande@gmail.

com

9/18/2016 Prof.Dr.R.R.Deshpande 1

http://www.ayurvedicfriend.com/

mailto:[email protected]

mailto:[email protected]

CVS Examination

9/18/2016 2Prof.Dr.R.R.Deshpande

Before CVS Examination

• Before CVS Examination do –• 1) Pulse Examination• 2) Look for clubbing of nails• 3) Look for Cyanosis• 4) Check pulsations at peripheral vessels like

Femoral artery, Popliteal artery, Dorsalis Pedis artery, prominence of neck veins


Before CVS Exam -Do Pulse Examination


Before CVS Exam – Look for clubbing


Before CVS Exam – Look for central Tongue Cyanosis


Before CVS Exam – Look for Leg oedema


Before CVS Exam – Look for Neck veins


Systemic Examination of CVS

• 1) Inspection

• 2) Palpation

• 3) Percussion

• 4) Auscultation


Inspection of chest

• 1) Shape of precordium• 2) Apex beat

• 3) Pulsations outside the precordium • A) Suprasternal• B) Epigastric• C) Neck vein


Shape of Precordium

• Symmetry of Precordium

• Look whether precordium is retracted or bulging or normal


Apex Beat

• Apex beat is outermost point of cardiac impulse. It comes in contact with chest wall

• Apex beat should be seen tangentially from side & below .Up & down movements are better appreciated ,when we look tangentially


Apex beat inspection tangentially from side


Apex beat inspection tangentially from below


Apex Beat

• In few conditions Apex beat may not be visible • Emphysematous chest ,Muscular individual, Apex

beat is situated below sternum ,pendulous breast in females

• In these conditions to look Apex beat ,give sitting position to patient ,leaning forward

• Apex beat is observed below left nipple .It should not be too prominent ,nor too feeble


Pulsations outside the precordium

• A) Suprasternal pulsations are due to Carotid Artery

• B) Epigastric pulsations are due to descending abdominal Aorta – To check epigastric pulsations ,patient should hold breath during expiration

• C) Neck veins are prominent in RVH,CCF


Inspection for Epigastric pulsation due to abdominal aorta


Palpation of chest

• Apex beat• • A) Position• B) Character

• C) Rate • D) Rhythm


Palpation – Apex beat

• To palpate Apex beat ,we use flat hand ,ulnar border of palm & tip of fingers

• After locating Apex beat ,mark the point as cross ,with ball pen


Palpation by flat of hand


Palpation by ulnar border of hand


Palpation by tip of fingers



• Palpate sternum .Palpate 2nd rib on the Left side .Below 2nd rib is 2nd intercostal space

• Normal Apex beat – Left 5th Intercostal space ,medial to mid clavicular line

• Apex beat can be in 4th Left intercostal space



• In some patients ,Apex beat may not be palpable ,because –

• It may be behind rib or person may be muscular

• In this case give Left lateral position or sitting position to the patient & try to locate Apex beat


If Apex beat is not seen or palpated in muscular individual ,palpation in left lateral position


Percussion of chest

• 1) Left border of heart • 2) Right border of heart

• Left border is more important ,because it is formed by left ventricle

• Right border is formed by right ventricle • Inferior border is formed by right ventricle


Second intercostal space


Percussion of Left border of heart

• Start percussion from anterior axillary line at the level of apex beat .Go from lateral to medial .Mark Point at which resonant note changes to dull note

• Now go up one intercostal space up & percuss from lateral to medial & mark point of dullness

• Now again go up one intercostal space up & percuss from lateral to medial & mark point of dullness

• Joining of these 3 points ,will form left border of heart


Percussion for left border of heart


Mark the point of dull note


Left border of heart determined


Percussion of Right border of heart

• It is situated behind right sternal border • We start percussing from right 2nd intercostal

space ,down ,up to Liver dullness • Then we percuss from lateral to medial • We will proceed from below upwards ,step by

step .Each time one intercostal space up .• Joining these points will give right border of

heart


Percussion for right border of heart


Right border of heart determined


Percussion of chest

• If there is abnormal feel like Thrill ,it should also be noted


Auscultation of chest

• Auscultation of heart sounds & additional sounds in following areas –

• 1) Mitral area • 2) Tricuspid area• 3) Aortic area• 4) Pulmonary area



Sr.No Valve Area

1 Mitral Area Located at Apex

2 Tricuspid Area 4th intercostal space ,just lateral to sternum

3 Aortic Area 2nd right costal cartilage

4 Pulmonary area 2nd left intercostal space ,just lateral to sternum


Mitral area for Auscultation


Tricuspid area for Auscultation


Aortic area for Auscultation


Pulmonary area for Auscultation



• Note that Valves are not located at the area ,mentioned in front of Valve

• All valves are located below the sternum

• These are areas ,where conduction of sound is better from corresponding valve


Auscultation of chest – Mitral Area

• Put diaphragm on Mitral area • Heart sounds should be auscultated ,always with

simultaneous palpating carotid artery pulsations ,to distinguish in between first & second heart sounds

• First heart sound coincides with carotid pulsation

• In Mitral area first heart sound is loud with compare to second heart sound


Auscultation at Mitral area


Auscultation of chest – Tricuspid Area

• Put diaphragm on Tricuspid area

• Heart sounds should be auscultated ,always with simultaneous palpating carotid artery pulsations ,to distinguish in between first & second heart sounds

• First heart sound coincides with carotid pulsation• In Tricuspid area first heart sound is loud with

compare to second heart sound



• First heart sound is due to closing of Atrio Ventricular valves

• So in Mitral & Tricuspid area ,First Heart sound is heard better


Auscultation of chest – Aortic Area

• Put diaphragm on Aortic area


• First heart sound coincides with carotid pulsation• In Aortic area second heart sound is loud with

compare to first heart sound


Auscultation at Aortic area


Auscultation of chest – Pulmonary Area

• Put diaphragm on Pulmonary area


• First heart sound coincides with carotid pulsation• In Pulmonary area second heart sound is loud with

compare to first heart sound



• Second heart sound is due to closing of Aortic & Pulmonary i.e Semilunar valves

• So in Aortic & Pulmonary areas ,Second Heart sound is heard better


Auscultation

• By Auscultation at these four areas ,we get rough idea about cardiac cycle

• Gap between first & second heart sound is Ventricular systole

• Gap between second & first heart sound is Ventricular Diastole


Auscultation

• Also Auscultate abnormal sounds like murmur

• Decide type of murmur ,to understand the

pathology behind it


Provisional & Confirm diagnosis

• By Clinical examination ,some times we can make provisional diagnosis

• In this case clinical findings should be correlated with Investigations like ECG, Stress or Treadmill Test ,2 D Echo, Angiography etc


Please see also Videos

• Copy ,Paste Link as URL• CVS Examination -- By Prof.Dr.R.R.deshpande

• https://youtu.be/Js3w5hrbjgg

9/18/2016 Prof.Dr.R.R.Deshpande 54

https://youtu.be/Js3w5hrbjgg

Prof.Dr.R.R.Deshpande

• Sharing of Knowledge

• FOR

• Propagating Ayurved


Cardio Vascular System Examination

Education