The document summarizes the clinical examination of the cardiovascular system. It outlines the key steps in examining the heart, including inspection of the chest shape and pulsations, palpation of the apex beat and other areas, percussion of the cardiac borders, and auscultation of the heart sounds at different locations. It then provides the normal findings for each part of the examination, such as the location of the apex beat, normal heart sounds, and absence of murmurs, thrills, or other abnormalities.

1. Clinical Examination of Cardio – Vascular
system
(or)
Clinical examination of chest for Heart
Chiranjeevi Kumar
AIIMS - Bhopal

2. Cardiac Exam
The cardiac exam includes:
•Examination of Arterial pulses
•Examination of jugular venous pressure
•Inspection, palpation and percussion of
Precordium and auscultation of the 4 cardiac
areas with the diaphragm

4. General Findings

5. General Findings

6. General Findings

8. General Findings

14. Assessment of central venous pressure.

16. • Top line – level of the higest visible point of
distention
• Bottom line – level of the sternal angle
• Measure: the vertical distance between the
sternal angle and the highest level of jugular
distention

23. Inspection
Shape Of The Chest,
Bulgings or depressions
Work Of Breathing,
Scars, Bruising Or Pacemaker
Sites,
Apical Impulse
Any Visible Pulsations

30. Palpation

36. Percussion of the chest
• Percussion of the chest for cardiac border

37. Auscultation

43. Auscultation of the Heart. B. Lateral.

44. Auscultation of the Heart. C. Sitting.

47. • Inspection
• Shape of chest – Normal, No precordial bulging or depression
• Symmetry of chest – bilaterally symmetrical
• Pulsations
– Apical Impulse – Visible (depends) or not visible -(nipple)
– Abnormal pulsations – Not Visible
• Dilated or engorged veins – Not present
• No Scars
• Swelling -
• Palpation
• Tenderness and Temparature
• Apex beat
– Location – left 5th ICS ½ inch medial to mid clav. line
– Character - Normal
• Parasternal heaves - Absent
• Thrills - Absent
• Direction of flow in veins - Not visible

48. • Percussion
• Boarders of heart
– Right – cannot be percussed because it is retrosternal
– Left - percussed,coincide with apex beat and it is
3,4,5 ICS
• Auscultation
• 1st heart sound – better heard over tricuspid and mitral
areas coincide with carotid pulse. Sounds like Lubb,
prolonged, low pitch.
• 2nd heart sound – better heard over aortic and
pulmonary areas, sounds like Dubb, high pitched, short
duration.
• No Murmurs
• Gallop Rhythm

49. Thank You