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Examination of Cardiovascular System

The document outlines the scope and components of a cardiovascular examination, including anatomy, symptoms, and signs associated with cardiovascular conditions. Key symptoms discussed include chest pain, dyspnoea, ankle swelling, and palpitations, while important signs include arterial pulses, blood pressure, and jugular venous pressure. The document also emphasizes the significance of thorough history taking and physical examination techniques in assessing cardiovascular health.

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Wanga Charlene
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14 views37 pages

Examination of Cardiovascular System

The document outlines the scope and components of a cardiovascular examination, including anatomy, symptoms, and signs associated with cardiovascular conditions. Key symptoms discussed include chest pain, dyspnoea, ankle swelling, and palpitations, while important signs include arterial pulses, blood pressure, and jugular venous pressure. The document also emphasizes the significance of thorough history taking and physical examination techniques in assessing cardiovascular health.

Uploaded by

Wanga Charlene
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Examination

of
Cardiovascular System

Dr. MTL NYO


FCP(SA)
Cert Rheum (Phys)
Internal Medicine
Scope of Cardiovascular Examination:
1. Anatomy
2. Important cardiovascular symptoms
• Chest pain and heaviness
• Dyspnoea, orthorpnoea, paroxysmal nocturnal dyspnoea (PND)
• Ankle swelling
• Palpitations
• Syncope, presyncope and dizziness
• Intermittent claudication
• Fatigue
Scope of Cardiovascular Examination:
3. Important cardiovascular signs
• Positioning the patient
• General : respiratory distress, cachexia
• Hands (Clubbing, splinter haemorrhages, Osler’s nodes, Janeway
lesions, Tendon xanthomata)
• Arterial pulses (rate, rhythm, character, volume, all pulses, radio-
femoral delay)
• Blood pressure
• Face (Jaundice, xanthelasmata, mitral facies, high arched palatae)
• Neck (carotid arteries, jugular venous pressure-”JVP”)
• Precordium
 Inspection (shape of chest wall, surgical scar, pace-maker)
 Palpation (apex beat position, apex beat character, palpable heart
sounds, thrills, parasternal lift)
 Auscultation
 Where to auscultate (Mitral, Tricuspid, Pulmonary & Aortic valves)
 Heart sounds (Intensity of S1&2, extra heart sounds S3&4,
splitting, additional sounds, murmurs, pericardial friction rub)
• The back, Abdomen, Lower limbs (Edema), PVD, Varicose veins
Basic anatomy of cardiovascular
system
Important cardiovascular symptoms
(History taking)
Chest pain:
Ischaemic chest pain (Angina or myocardial infarction)
“Due to accumulation of metabolites from ischaemic muscle
following complete or partial obstruction of a coronary
artery”
• Retrosternal crushing pain, heaviness or discomfort

• Typically provoked by exertion or emotion

• Typically relieved by rest or GTN or both

• May radiate to the jaw or to the arms (usually left arm)

• Pain is not well localised

• Not positional and not affected by respiration


Dyspnoea:
The awareness that an abnormal amount of effort is required
for breathing
Causes
1. Cardiac disease
Eg. Congestive cardiac failure, mitral stenosis
2. Respiratory disease
3. Anaemia
4. Acidosis
5. Lack of physical fitness

Cardiac dyspnoea is typically chronic and occurs with exertion


NYHA classification of dyspnoea:
Class I: Disease present but no dyspnoea or dyspnoea
only on heavy exertion

Class II: Dyspnoea on moderate exertion

Class III: Dyspnoea on minimal exertion

Class IV: Dyspnoea at rest


Orthorpnoea:
Dyspnoea that develops when a patient is supine.
• Redistribution of interstitial oedema between upper and
lower zones of the lungs
• Effect of gravity on diaphragmatic movement

Causes
1. Cardiac failure
2. Uncommon
• Massive ascites; Pregnancy; Bilateral diaphragmatic
paralysis; Large pleural effusion; Severe pneumonia

Patients with severe orthorpnoea spend the night sitting up in a


chair or propped up on numerous pillows in bed.
Paroxysmal nocturnal dyspnoea (PND):
Severe dyspnoea that wakes the patient from sleep so that he
or she is forced to get up gasping for breath.

Resorption of peripheral oedema at night while supine

Acute rise in pulmonary venous and capillary pressures

Transudation of fluid into the interstitial tissues

Increased work of breathing (dyspnoea)


Ankle Swelling (bilateral):
• Ankle oedema of cardiac origin is usually symmetrical and
worst in the evenings, with improvement during the night.

• As failure progresses, oedema ascends to involve the legs,


thighs, genitalia and abdomen.

• There are other (more) common causes of ankle oedema


than heart failure
Palpitations:
An unexpected awareness of the heartbeat

• slow or fast

• regular or irregular

• how long they last


Syncope, presyncope and dizziness:

Syncope is a transient loss of consciousness resulting from


cerebral anoxia, usually due to inadequate blood flow.

Presyncope is a transient sensation of weakness without loss


of consciousness.

“Dizziness”
• Presyncope (lightheadedness) Vs

• Vertigo (feeling that one or one’s surroundings are moving


when there is no actual movement – may feel off balance,
spinning, whirling).
Intermittent claudication:
Pain in one or both calves, thighs or buttocks when one walks
more than a certain distance.

• This distance is called the ‘claudication distance’.

• The claudication distance may be shorter when patients


walk up hills.

• Intermittent claudication suggests peripheral vascular


disease with a poor blood supply to the affected muscles.
Fatigue:
A subjective feeling of tiredness

• A common symptom of cardiac failure

• A reduced cardiac output and poor blood supply to the


skeletal muscles.

• Many other causes of fatigue: Lack of sleep, anaemia,


depression, etc.
Important Cardiovascular Signs
(Physical Examination)
Right side of the patient

45°
The Hands:
• Clubbing of fingers and toes

• Splinter haemorrhages

• Osler’s nodes

• Janeway lesions

• Tendon xanthomata
Clubbing
Increase soft tissue of the distal part
• Loss of angle between the nail bed
and the nail fold (Schamroth’s sign)
• Drumstick appearance
• Fluctuation and softening of the nail
bed (increased ballotability)
• Increased convexity of the nail
Splinter Haemorrhages

Osler Nodes Tendon Xanthomata


Arterial pulses :
Pulses Rate Ryhthm Compare Bruit
(Regular Vs Irregular) (with the opposite side) (Auscultate)

Radial X X X

Brachial X

Carotid X X
Never simultaneously

Femoral X X

Popliteal X

Dorsalis pedis X

Posterior tibial X

• Radio-femoral delay & radial-radial delay


Radial
pulse

Brachial
pulse
Carotid
pulse

Femoral
pulse
Popliteal pulse

Dorsalis pedis
pulse

Posterior tibial
pulse
Radio-femoral delay

Radial-radial delay
Jugular venous pressure (JVP) :
• 45 degrees to the horizontal -
sternal angle roughly in line with
the base of the neck

• Good lighting conditions


Jugular venous pressure (JVP) :

1. Visible but not palpable


2. A complex wave form, usually flicker twice
3. Moves on respiration—normally decreases on inspiration
4. Obliterated by light pressure at the base of the neck
5. Abdominojugular (Hepatojugular) reflex present
Precordium Examination :
1. Inspection
Shape of chest wall
Surgical scars, pace-maker
2. Palpation
Position of the apex beat
Palpable heart sounds, parasternal lift
3. Auscultation
Where to auscultate
Heart sounds (intensity S1-2, extra heart sounds S3-4)
Inspection : shape of chest wall

Pectus Carinatum Pectus Excavatum Kyphoscoliosis


(Pigeon Chest) (Funnel Chest)
Position of the apex beat:
• The most lateral and inferior point at which the palpating
fingers are raised with each systole

• Normal position: left 5th intercostal space, mid-clavicular line

• If displaced laterally or inferiorly, or both  enlarged heart


Palpable heart sounds Parasternal lift

S2

S1

S1: apex beat Left sternal border


S2: 2nd ICS, left sternal border
Auscultation:
Mitral valve area  Tricuspid  Pulmonary  Arotic
Heart sounds S1 : Closure of mitral and tricuspid valves
S2 : Closure of aortic and pulmonary valves
Extra heart sounds S3 : Heard just after S2
S4 : Heard just before S1
Edema:
• An abnormal accumulation of fluid in the interstitium

• 2 types: Pitting and non-pitting edema

• If pitting oedema is present, note its upper level Eg.


 ‘pitting oedema to mid-calf’ or
 ‘pitting oedema to mid-thigh’

• Severe oedema can involve the abdominal wall and the


scrotum
Edema:
Pitting bilateral lower limb oedema
• Cardiac: congestive cardiac failure
• Drugs: calcium antagonists
• Liver: Cirrhosis
• Renal: Nephrotic syndrome
• GIT: Malabsorption, PLE
• Beri-beri (wet)
• Cyclical edema

Pitting unilateral lower limb oedema


• Deep venous thrombosis
• Compression of large veins by tumour or
lymph nodes
Abbreviations :
GTN Glyceryl trinitrate
NYHA New York Heart Association
GIT Gastrointestinal tract
PLE Protein losing enteropathy

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