This document provides an overview of cardiovascular system examination. It discusses symptoms associated with cardiovascular issues and methods for physical examination including pulse examination, heart auscultation areas, and percussion of heart borders. Key examination techniques are outlined such as assessing pulse rate, rhythm, volume and character. Common pulse abnormalities like pulsus deficit and pulsus alternans are also defined.

1. CARDIOVASCULAR SYSTEM
EXAMINATION
Dr. Aniket A. Shilwant
Assistant Professor
Sharir Kriya Dept.
GJP-IASR, CVM University
ayuraniket18@gmail.com

2. CARDIOVASCULAR
SYSTEM
HEART BLOOD
BLOOD
VESSEL

3. Associated Symptoms
Physical Examination

4.  Chest Pain – Oesophageal Spasm, Musculoskeletal,
Angina, MI, Respiratory origin
 Palpitation – unexpected awareness of heart beating
Q – Onset & Termination
Frequency & Duration Of Episodes
 Dyspnea – Musculoskeletal, Angina, Respiratory origin
 Cyanosis
 Tingling, Numbness
 Fainting, Syncope
*Unstable Angina

5. Notes –
Cardiac Chest Pain –
SOCRATES
S – Site
O – Onset
C – Character
R – Radiation
A – Associated Symptoms
T – Timing
E – Exacerbating or Relieving factors
S – Severity

6. PULSE EXAMINATION

7. 1. Anacrotic Limb
2. Catacrotic Limb
3. Catacrotic notch
• Pre - Catacrotic
• Post - Catacrotic
Method of Examining Radial Pulse
• Subject is made to sit comfortably with forearm placed in mid or semi prone position, with wrist
slightly flexed.
• Tips of the middle three fingers (index finger, middle finger and ring finger) are placed over the
radial artery below the wrist at the base of thumb.
• Index finger is used to occlude blood flow from radial artery.
• Ring finger is used to occlude retrograde flow of blood from ulnar artery through palmar arch.
• Middle finger is used to assess the pulse.

8. Pulse points-
1) Temporal A – Temporal Region
2) Carotid A – In the Neck
3) Brachial A – At the Elbow
4) Radial A – At the lower end of Radius, at root of Thumb
5) Femoral A – In the Groin
6) Popliteal A – In the Popliteal Fossa
7) Dorsalis Pedis A – At the Dorsum of Foot
8) Posterior Tibial A – Behind Medial Malleolus

9. 1) Rate
Normal- 72 to 80 per min
Phy. Increase – Newborns, Emotions, Pregnancy, Exercise
Phy. Decrease – Sleep, Athletes
Abnormal-
Tachycardia >100 per min
Pyrexia, Hyperthyroidism, Atrial fibrillation, Anemia
Bradycardia < 60 per min
Myxedema, Hypothyroidism, Hypothermia, Heart block

10. 2) Rhythm-
a) Regular or Irregular
b) If Irregular then-
Regularly Irregular OR Irregularly Irregular
3) Character-
a) Noted by normal rise-maintenance-fall
4) Tension-
a) It is the pressure applied to feel the artery at its best
Weak (Feeble) or Strong

11. 5) Volume-
a) It is the amplitude of movement or expansion of artery during passage of pulse
wave
Hyperkinetic or Hypokinetic
6) Condition of vessel wall-
a) Depending on elasticity of vessel wall the rate of pulse differs
*Vessel wall not palpable in young adults & children
But palpable only in old ages

12. 7) Delayed pulse-
Radio – Radial Delay
Radio – Femoral Delay

13. PULSE WAVE ABNORMALITIES
 Pulsus Deficit - Pulse rate is less than the heart rate.
Atrial fibrillation, when the stroke volume is reduced.
 Pulsus Alternans - The amplitude of every second wave in pulse tracing is relatively smaller. It is because of
the alternate variation in the force of ventricular contraction.
Severe myocardial diseases, Atrial fibrillation
 Pulsus Corrigans / Water Hammer Pulse - Rapid upstroke and an equally rapid downstroke. It is also called
collapsing or Corrigan pulse.
Aortic regurgitation, patent ductus arteriosus
It is best felt by raising the arm of the subject and holding it by grasping the wrist with palm of the observer.
 Weak / Thready Pulse - The volume of pulse becomes very feeble and is hardly felt at the arteries.
Severe fall in the stroke volume, severe hemorrhage, Severe Chills.
 Anacrotic / Slow Rising Pulse - Slow ascending limb which has a notch called anacrotic notch.
Aortic stenosis, due to slow ejection

14. PHYSICAL EXAMINATION OF HEART

15. 1) Inspection
2) Palpation
3) Percussion
4) Auscultation
5) ECG

16. INSPECTION
1) Look for any deformity over chest or back
Lordosis - Kyphosis - Scoliosis
2) Look for bulge over precordium due to cardiomegaly or any other reason
3) Look for pulsations visible over-
a) Apex beat
b) Neck – Anxiety, Hyperthyroidism, Hypertension
c) Epigastric region – Thin persons, Rt Ventricle Hypertrophy

17. PALPATION
Apex Beat-
8-10 cm away from mid-sternal line on 5th Intercoastal space within mid-clavicular
line
Significance-
1) Enlargement of heart due to hypertrophy may shift the apex beat
2) Pulling or pushing of mediastinum due to lung disease may shift position of
apex beat
3) Tapping or stroking apex beat seen in mitral stenosis

18. PERCUSSION
TECHNIQUE

19. Percussion of CVS (Heart)
 To find heart borders
 Shifting of Apex beat

20. PERCUSSION
1) Right border of Heart
a) Start from Rt. mid-clavicular line downwards until resonance changes to
dullness (upper border of liver)
b) Along this level start from mid axillary line move towards Rt sternal margin
c) Rt border of heart lies just behind the sternum
2) Left border of Heart
a) Start from mid axillary line on 5th, 4th and 3rd inter coastal line move towards
heart
b) Until resonance changes to dullness
c) The points showing dullness is marked by ink spots this is left border of heart

21. Auscultation Areas of CVS
 Mitral Area
 Tricuspid Area
 Pulmonary Area
 Aortic Area

22. AUSCULTATION
1) Mitral Area – 5th Lt ICS, 8-10cm away from midsternal line
2) Tricupsid Area – Left lower end of Xiphoid Process
3) Aortic Area – Rt Sternal Margin IInd ICS
4) Pulmonary Area – Lt Sternal Margin IInd ICS

23.  Intensity of heart sounds noted in different areas.
 Splitting of Heart sounds

24. Have a Healthy Heart …

25. Thank You All !!!
Dr. Aniket A. Shilwant
Assistant Professor
Department of Kriya Sharir
GJP-IASR, CVM University
Email –
ayuraniket18@gmail.com
http://ayugjac.edu.in/Staff_CV.aspx?dl=dn3Mja19480dn3Mja19
http://scholar.google.co.in/citations?user=636K2sMAAAAJ&hl=en
https://www.researchgate.net/profile/Aniket_Shilwant