CVS Physical Examination Hadeel Khadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-Qura University.

CVSPhysical

Examination Hadeel Khadawardi, teaching assistant at Internal

Medicine Department, Faculty of Medicine, Umm Al-Qura University

General Approach

Vital Signs

Position 45

Peripheral Exam Pericardium Exam

Hand Wrist + Arm Face Neck

Inspection Palpation Auscultation

CVS Exam

Hand

Nail Dorsum Palm

Nail

Clubbing

Peripheral Cyanosis

Splinter Hemorrhage

What are the causes of clubbing?

Hand

Dorsum

Muscle Wasting

Tendons xanthomata

Hand

Palm

Osler’s Nodules

Janeway Nodules

Palmer Xanthomata

Hand

Wrist + Arm Radial Pulse Rate Rhythm Volume Character Radio-radial delay Radio-femoral delay

Blood Pressure

What are the different characters of arterial

pulses ?

Face

Eyes Cheeks Mouth

Face

Eye

Jaundice

Pallor

Xanthelasma

Face

Cheeks

Mitral Face

Face

Mouth

Peripheral cyanosis Central cyanosis Jaundice Infected teeth High arch palate

Neck

Carotid Pulse

JVP

Pericardium

Inspection

Scar

Skeletal Deformity

Visible Apex Beat

Palpation Apex Beat - Site - Size - Character Heave Thrill

What can you do if you couldn’t feel the apex beat?What are the possible causes of difficult apex beat palpation?

What are the different characters of apex beat?

Pericardium

Auscultation Pericardium

Mitral area = Apex beat

Aortic area

Tricuspid area

Pulmonary area Axilla

Carotid

Maneuver for aortic

regurgitation

How to present your findings:

• S1 & S2

• Splitting of S2

• Added sounds

• Murmur

What are the causes of loud S1 & S2 ?

What are the causes of soft S1 & S2 ?

What are the causes of wide, fixed & reversed splitting of S2 ?

What are the causes of S3 & S4 ?

How to present a sound of murmur:

Timing

Sub timing

Radiation

Grade

Area of greatest intensity

What are the timing and sub timing of cardiac

murmurs ?

Dynamic Maneuver

All murmur increase with increases of venous return

Except in HOCM & MVP

Squatting to standing Standing to squatting Valsalva maneuver Respiration: Inspiration Expiration Isometric exercise (hand

grip)

Back

Palpate for sacral edema

Auscultate lung bases

Abdomen Enlarged liver

Ascites

Splenomegaly

Aortic aneurysm

Lower Limbs Pulses: - Femoral - Popliteal - Posterior tibial - Dorsalis pedis

Pitting edema Achilles tendon xanthomata Signs of PVD Signs of DVT

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