Assessment

1. Introduction of Normal Anatomy

3. Different Valves of the Heart and Normal
Blood Flow

4. 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

5. General examination
• Examination of the hands
• Cyanosis(central and peripheral)
• Look for any malformation
• Examination of eye
• Examination of lower extremities

6. Examination - Hands
• Clubbing
• Splinter haemorrhages (infective endocarditis)
• Osler’s nodes (tender)
• Janeway lesions (non-tender)
• Xanthomata (Hyperlipidaemia)

7. Clubbing
Splinter Haemorrhages

8. Cont
Clubbing Janeway lesions

9. General examination cont
Cyanosis (central) Peripheral cyanosis

10. Did Abraham Lincoln have Marfan’s Syndrome?
High arched palate

11. Cont
• Examination of abdomen may be important to see
manifestation of cardiac illness
– Tender hepatomegaly
– Pulsatile liver (tricuspid regurgitation)
– Ascites
– Splenomegaly
– Abdominal aortic aneurysm

12. Examination of the Arterial pulse
• Radial artery
• Rate (normal = 60-100)
– Bradycardia (<60)
– Tachycardia (>100)
• Rhythm
– Regular
– Irregular

13. Cont
Radial pulse Other area to check pulse

14. Peripheral Pulses
Dorsalis pedis pulse Posterior tibial pulse

15. 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

16. Cont

17. cont
• It has different parts
– Cuff
– Bladder

18. 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

19. How to measure

21. 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.
• Estimate CVP maximal 3cm from sternal angle + 5cm from
atrium (Right atrial pressure)

22. 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

23. Jugular Venous Pressure

27. Examination of Heart/Precordium
• Inspection
• Palpation
• Auscultation
• Percussion ???

28. Precordium - Inspection
• Scars
• Chest deformity
– Pectus excavatum
– Pectus carinatum
• Pacemaker box
• Apex beat

29. Precordium - Palpation
• Apex beat
– Location
– Character
• Heaving
• Thrusting
• Double
• Tapping
• Paradoxical
• Left parasternal heave
• Thrills (palpable murmurs)
– Systolic
– Diastolic
• Palpable P2 (pulmonary hypertension)

30. Precordium – Auscultation
Heart Sounds
• Bell – low pitched sounds
• Diaphragm – high pitched sounds
• Mitral Tricuspid Pulmonary Aortic areas
• S1 (first heart sound)
• S2 – Splitting (A2, P2)

32. "Abnormal or ectopic heart sounds are known as heart murmurs."
It occurs when there is some valvular or anyother abnormality causing
turbulence of blood flow either due to great velocity of ejection or its
regurgitation.
Types of murmur
1
. Aortic Stenosis
2
. Aortic Regurgitation
3
. Mitral Regurgitation
4
. Mitral Stenosis

33. 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

34. Thanks