6. Examination of cardiovascular system
• General examination
• Examination of vessels and Blood pressure
– Pulse
– Blood pressure
– Jugular venous pressure
– Examination of central(neck) and peripheral vessels
• Pericardial examination
– Inspection
– Palpation
– Auscultation and
– Percussion??
7. General examination
• Examination of the hands
• Cyanosis(central and peripheral)
• Look for any malformation
• Examination of eye
• Examination of lower extremities
13. Cont
• Examination of abdomen may be important to see
manifestation of cardiac illness
– Tender hepatomegaly
– Pulsatile liver (tricuspid regurgitation)
– Ascites
– Splenomegaly
– Abdominal aortic aneurysm
14. Examination of the Arterial pulse
• Radial artery
• Rate (normal = 60-100)
– Bradycardia (<60)
– Tachycardia (>100)
• Rhythm
– Regular
– Irregular
• Radio-femoral delay (coarctation of the aorta) – comparing radial and femoral
pulse
• Character and volume volume
17. Blood Pressure Measurement
• Instrument
– Sphygmomanometer
– Anaeroid and mercury type
• Blood pressure has two component
– Systolic
– Diastolic pressure
• Normal <140/90 mmHg (lower in diabetes)
• Korotkoff sounds
• Use larger cuff width for large arms
20. SELECTING THE CORRECT BLOOD PRESSURE CUFF
• Width of the inflatable bladder of the cuff should be about
40% of upper arm
• circumference (about 12–14 cm in the average adult)
• Length of inflatable bladder should be about 80% of upper
arm circumference (almost long enough to encircle the arm)
• If anaeroid, recalibrate periodically before use
21. GETTING READY TO MEASURE BLOOD PRESSURE
• Ideally, ask the patient to avoid smoking or drinking caffeinated
beverages for 30 minutes before the BP is taken and to rest for at
least 5 minutes.
• Check to make sure the examining room is quiet and comfortably
warm.
• Make sure the arm selected is free of clothing or any problem on
the hand
• Palpate the brachial artery to confirm that it has a viable pulse.
• Position the arm at the level of heart
• If the patient is seated, rest the arm on a table a little above the
patient’s waist; if standing, try to support the patient’s arm at the
midchest level.
24. Jugular Venous Pressure
• JVP reflects pressure in the right atrium, or CVP also blood
volume, status of tricuspid valve and diastolic event in RV.
• Best assessed from pulsations in the right internal jugular vein.
• It shouldn’t be done in children < 12 yrs.
• The JVP is the elevation at which the highest oscillation point, or
meniscus, of the jugular venous pulsations is usually evident in
euvolemic pts
• Estimate CVP maximal 3cm from sternal angle + 5cm from atrium
(Right atrial pressure)
25. Jugular Venous Pressure
• Steps
– Position patient 30/45
– Tangential light
– Identify internal jugular venous pulsation(right)
– Extend a long rectangular object or card horizontally from this point
and a centimeter ruler vertically from the sternal angle, making an
exact right angle.
– Measure the vertical distance in centimeters
38. Heart Murmurs cont….
Grading of Murmurs
1. Heard only with special effort
2. Soft, but readily detected
3. Prominent, but not loud
4. Loud, usually accompanied by a thrill
5. Very loud (stethoscope angled on chest)
6. Heard with stethoscope off the chest