Cardiovascular system examinations
Diaphragm at pulmonary - listen on inspiration for stenosis and regurg.
Diaphragm at aortic - listen on expiration for stenosis.
Diaphragm at tricuspid - listen on inspiration for stenosis and regurg
Sit patient forward: Diaphragm at tricuspid - listen on inspiration for regurg.
Turn patient back - Diaphragm at apex - listen on expiration for mitral regurg. Then move up axilla.
Diaphragm at lung bases - listen for pulmonary oedema, LVF
Bell at apex (for mitral stenosis and +heart sounds), then turn patient laterally: repalpate apex and listen with bell, continuing up axilla
Introduction, explanation, confidentiality and consent - positition patient at 45 degree angle.
- distress? Obvious scars? Medical equipment?
- pallor, clubbing, splinter haemhorrages (fingernail beds), Osler's nodes (lateral aspects of fingers), Janeway lesions (palms), tendon xanthomas, capillary refill, Marfan's syndrome.
- Radial pulse: synchrony, note rhythm. Tendon xanthomas. Take BP
- Eyes: arcus senilis, anemia, xanthelasma. Malar flush. Mout: good dentition?, central cyanosis, Marfan's syndrome (high arched palate)
- JVP<3cm?, carotid pulse (listen first with bell and note character and volume, check for radiation of AS or bruits
: visible heaves, audible prosthetic valves
- Apex beat, heaves and thrills, oedema (sacral and peripheral)
Introduction, explanation, confidentiality and consent - 45 degree angle
- distress? deformities? pain? walking aids? footwear, dressings? then come closer, varicose veins? oedema? colour of feet, ulcers? gangrene? check heel and between toes.
- feel for temp. of all limbs (use back of hand moving down the limbs bilaterally), capillary refill<2sec, pitting oedema? calf tenderness? measure calf diameter?
Carotid (Note - auscultate for bruits before palpation
Abdominal aorta (just above umbilicus)
Popliteal (with knee bent, use 2 hands)