Cardiovascular Examination - Explanation

Thank You Jackson I'd now like to examine your heart please can I ask you to undress to your waist and please take your shoes and socks off thank you thank so please come to the counter as mr. Jackson is getting onto the couch I'm looking for any signs of discomfort I'm looking to see any ease of movement and whether he's breathless I then stand back and have a look at the patient as a whole I'm checking for any obvious abnormalities such as discomfort at rest tachypnea pallor cyanosis scars or items of note around the bedside such as intravenous infusions that might be present on a ward look how mr. Jackson is positioned he's reclined at 45 degrees his hands are by his side and his chest is fully exposed for female patients after initial inspection it is usually customary to cover their chest and to their procore diem is examined please I have a look at your hands thank you in the hands I'm looking for signs of clubbing peripheral cyanosis cigarette tar staining or splinter hemorrhages this should only take a very short period of time before moving on to examine the radial pulse I'd like to feel your pulse now please you when examine the radial pulse is important to identify both the rate and the rhythm and also allow at least 15 seconds to write a good estimate of the patient's pulse rate thank you let me have both your hands by examining both the radial pulses I'm able to identify any evidence of radial radial delay thank you if I suspect able to grow vegetation then I examine for a collapsing pulse initially examining the radial pulse by the patient's side after warning them our brisk be raises arm above his head so I'm just going to raise your arm of your head thank you next I examine for the brachial pulses I have your arm please sir just an example for the pulse thank you this gives further insight into the volume the character of the pulse the brachial pulse is located medial to the biceps at the cubital fossa thank you I just like to examine your other arm please thank you I just like to measure blood pressure in your right arm please it is important to examine the patient's blood pressure at this point on the first occasion the blood pressure should be measured in both the right and left arm and of course the blood pressure should be measured standing if the patient is at risk of postural hypotension examination of the face may reveal a malar flush which is characteristic of mitral valve disease this is known as a mitral face sees I'd like to examine your face now please sir now she take your glasses off please look up for me examination of the conjunctiva may reveal evidence of anemia the iris may show in Arcis and around the eyes there may be evidence of xanthelasma can you please put your glasses back on can I should open your mouth and stick out your tongue please thank you it is essential to examine the mouth in a patient as poor dentition can be a source of bacterial endocarditis cyanosis will be evident from blue discoloration of the mucosa I lied examine the vein your neck please can you rest your head back and look to the left lovely thank you the internal jugular vein arises between the two heads of the sternocleidomastoid the medial and the lateral heads if the J BP is elevated then it can be measured as the vertical height from the sternal angle it's normally equal to or less than three centimeters eliciting the hepatic ocular reflux is normally unnecessary both of the cross-eyed pulses should be palpated but be sure to only feel one at a time to prevent the patient feeling faint please relax your head back I just like to feel the pulses in your neck you the examination of the procore diem is like any other examination and that should include inspection palpation and auscultation noting for the Karthik examination percussion of the heart is not required at this point you must ensure that the chest is fully exposed I just like to look at the front of your chest please can I ask you to put your arms by the side thank you excuse me it is important to inspect for previous operative scars for visible apical pulsation and listen for an audible click or prosthetic heart valves the apex is normally located at the fifth intercostal space left midclavicular line unless displaced by enlargement as well as any displacement the character of the apex bead is noted if the apex beat is hard to locate you can ask the patient to roll to their left but you will no longer be able to comment on the position of the apex I'm now going to feel for your heart excuse me and I'll just check its location a patient with the base of my hand just left the sternum might identify parasternal heave which would indicate right ventricular hypertrophy palpating over the valve other areas might identify the presence of a thrill occupation of the heart should start at the apex it is important to identify the first and second heart sounds then the additional sounds s3 or s4 and then any murmurs there are a number of strategies for auscultate in the heart and is likely you'll develop your own way of doing this however it is Orthodox to start at the apex and proceed towards the base of the heart if you need to time the murmurs then palpate the carotid artery a pulsation will indicate systole and now I'd like to listen to your heart please excuse me at first using the diaphragm I listen over the apex the first second and only additional heart sounds this area is ideal for listening for murmurs of mitral valve disease I then proceed to listen at the exhilarate for listening for the radiation of mitral regurgitation I then by using the bell listen over the apex again I'm listening for the low pitched murmur of mitral stenosis this moment can be accentuated by asking the patient to move to their left it can you move to your left please thank you again rest back I then proceed to the examination again by listening with the diaphragm at the lower left sternal edge in the second intercostal space on the left the pulmonary area and the second intercostal space on the right the aortic area murmurs have aortic stenosis often radiate to the base of the neck and sometimes be best heard in this location it's important to listen of course it Brewers this done turned in the left and then the right we ask the patient to hold their breath can you hold your breath please thank you thank you and breathe normally I often hold my breath at the same time as the patient as way of reminding me to ask the patient to breathe again can I just sit forward please to complete my examinations of record iam I listen at the left lower sternal edge for the early diastolic murmur of aortic regurgitation this is best heard in expiration you actually take a breathe a breath in and then breathe out and hold your breath please thank you breathe again while the patient remains in this position it is possible to listen at the lung basis for any evidence upon Redeemer please remember all left-sided heart murmurs are accentuated if a patient holds their breath in expiration and right-sided heart murmurs are accentuated a patient holds their breath in inspiration part of the card of us we examine examination of the rest of the peripheral pulses it is important to examine for both the dorsalis pedis and the posterior tibial pulses in all patients I'd like to examine the pulses in your feed please first thing I feel for the dorsalis pedis pulses and then the posterior tibial pulses finally both ankles should be inspected for peripheral edema sometimes edema can be tender so warn the patient before applying any pressure I'm now going to press behind your ankles I usually press about five seconds behind the media malleolus and then feel if any indentation remains afterwards if pitting edema is present identify the extent of the edema up the limbs if a patient is bed-bound look at the lowest point of gravity the sacrum in right heart failure there may be an indication for examination of the abdomen for evidence of ascites or Patterson or megali in addition patients with vascular disease require a full vascular examination including identification of any abdominal aortic aneurysm for those patients with a history of uncontrolled hypertension occasionally renal bruise can be heard nos potation indicating rino vascular disease examination of the eyes by fund Oscar P is dissolved in those patients with a history of diabetes hypertension or endocarditis bedside investigations would include recording of the temperature and urine analysis you

Channel: University of Leicester

Views: 861,797

Keywords: Dr Irene Peat FRCR FRCP, Dr Nicholas Port MBChB BSc, Jon Shears, Adrian Stanley, Irene Peat, Nicholas Port, University of Leicester, Medicine, Leicester Medical School, Cardiovascular Examination, CVS, cardiac, Radial Pulse, Brachial Pulse, Blood Pressure, Facial Examination, JVP, Carotid Pulse, Chest Inspection, Chest Palpation, Chest Auscultation

Id: ZFpSC6sbS1s

Length: 12min 49sec (769 seconds)

Published: Mon May 21 2012