Video 11 Examen del tórax Aparato cardiovascular

Jhojan Stiven's Marin Galeano

2 May 201914:07

Summary

TLDRThis script discusses the physical examination of the thorax with a focus on the cardiovascular system. It covers inspection, palpation, percussion, and auscultation techniques, highlighting the identification of various heart beats such as the apical impulse and its pathological implications. The video also touches on the significance of palpable thrills and vibrations in diagnosing valvular heart diseases. A step-by-step approach to examining the chest, including the use of maneuvers like the Rivero Carvalho test, is provided to differentiate between aortic and right ventricular beats.

Takeaways

🔍 The cardiovascular physical examination of the thorax starts with inspection, followed by simultaneous palpation, percussion, and auscultation.
👨‍⚕️ Inspection should be done from the right side of the patient or from the foot of the bed for a better tangential view.
💓 The precordial impulses, such as the apical impulse, are often visible and can be felt, especially in individuals under 40 years old.
📍 The apical impulse is normally located in the fifth intercostal space, medial to the midclavicular line. Its presence and characteristics can indicate various heart conditions.
🔄 Deviations in the location or intensity of the apical impulse may indicate left or right ventricular enlargement or hypertrophy.
📈 A more intense and sustained apical impulse suggests left ventricular hypertrophy, as seen in aortic stenosis or hypertension.
👂 The presence of an abnormal right ventricular impulse, visible and palpable, often indicates pathological conditions.
🫀 A visible and palpable impulse in the second left intercostal space can indicate pulmonary hypertension.
🖐️ Generalized thoracic impulses can be observed in various heart conditions, including hypertrophic or dilated cardiomyopathy.
🔊 Palpable thrills or murmurs, detected as vibrations, indicate turbulent blood flow and help in diagnosing valvular diseases.

Q & A

What is the initial step in the physical examination of the thorax in relation to the cardiovascular system?
-The initial step in the physical examination of the thorax in relation to the cardiovascular system is inspection.
Why is it recommended to perform palpation simultaneously with inspection during the cardiovascular examination of the thorax?
-Palpation is performed simultaneously with inspection because the hand tries to confirm what is perceived visually, providing a more comprehensive assessment.
What is the significance of the apical impulse in the cardiovascular examination?
-The apical impulse is a heartbeat that is typically observed in individuals under 40 years of age. It is usually palpable in the fifth intercostal space, medial to the left midclavicular line, and is an important indicator of cardiac health.
What are the typical characteristics of a normal apical impulse?
-A normal apical impulse has a space corresponding to the yolk of a finger and is a soft impulse that touches the hand for a few centiseconds and quickly retracts the skin.
What changes in the apical impulse might indicate pathological conditions?
-Changes in the apical impulse, such as its location extending towards the left (indicating left ventricular enlargement) or towards the right (indicating right ventricular enlargement), or changes in its intensity, can indicate pathological conditions.
How can the intensity of the apical impulse provide information about the heart's condition?
-If the apical impulse is more intense and sustained, it can indicate hypertrophy or enlargement of the left ventricle, as seen in conditions like aortic stenosis or hypertension.
What is the significance of the right ventricular impulse in the cardiovascular examination?
-The right ventricular impulse, when palpable, is always pathological and indicates the enlargement and hypertrophy of the right ventricle, which can be responsible for certain cardiac conditions.
What is the 'tríada de la pulmonar de Chávez' and why is it significant?
-The 'tríada de la pulmonar de Chávez' refers to a visible, palpable, and auscultatory (heard) pulse in the second intercostal space to the left of the sternum, which is indicative of pulmonary hypertension.
What are the general signs of a cardiac condition when observed through the thorax?
-General signs include generalized impulses, such as the direct diagonal impulse, which can indicate left ventricular hypertrophy, and other impulses that may be consequences of pulmonary hypertension.
How can the percussion of the precordial area help in the cardiovascular examination?
-Percussion of the precordial area helps in identifying the presence of a dilated right ventricle or pericardial effusion by assessing the resonance of the sternum and the presence of a displaced apical impulse.
What is the significance of the epigastric impulse in the cardiovascular examination?
-The epigastric impulse is typically associated with the aorta, but the Rivero-Carvalho maneuver can help determine if it is indeed from the abdominal aorta or the right ventricle by observing changes during deep inspiration.

Outlines

00:00

📚 Cardiovascular Examination Techniques

This paragraph discusses the steps involved in the physical examination of the thorax related to the cardiovascular system. It begins with inspection, followed by simultaneous palpation to confirm visual observations. Percussion is then performed, and auscultation is the final step. The paragraph emphasizes the importance of positioning oneself to the right of the patient or at the foot of the bed for a transverse view, which facilitates the observation of thoracic surface movements. It also describes the 'pulsation of the apex' or 'cardiac impulse,' typically observed in young individuals under 40 years. Modifications of this pulsation, such as its location and intensity, can indicate pathological conditions like hypertrophy of the left ventricle or volume overload. The paragraph also covers how to confirm these observations through palpation and special maneuvers.

05:02

💓 Identification of Cardiac Pulses and Pathological Indicators

The second paragraph delves into the identification and significance of various cardiac pulses observable on the thorax. It mentions the pathological nature of the right ventricular pulse, the 'pulsation of the heel of the hand' as an indicator of right ventricular hypertrophy, and the 'Chavez triad' related to pulmonary hypertension. The paragraph also describes other palpable phenomena such as thrills and vibrations associated with valvular heart disease. It explains the importance of palpation in diagnosing conditions like mitral stenosis and the use of percussion to identify an enlarged cardiac silhouette or pericardial effusion. Additionally, it touches on the assessment of epigastric pulsation to differentiate between aortic and right ventricular impulses.

10:04

🔍 Advanced Cardiac Auscultation and Percussion Techniques

This paragraph focuses on advanced techniques in cardiac auscultation and percussion. It discusses the identification of thrills, which are vibrations felt during palpation and are indicative of turbulent blood flow, often associated with organic heart disease. The paragraph explains the significance of thrills in the classification of heart murmurs and the importance of palpating for valvular vibrations, particularly the first heart sound, which can indicate mitral stenosis. Percussion is simplified to checking the sternum for resonance, which can reveal a dilated right ventricle or pericardial effusion, and to identifying an enlarged cardiac silhouette. The paragraph concludes with the Rivero-Carvalho maneuver to differentiate between abdominal aortic and right ventricular pulsations, especially during deep inspiration.

Mindmap

Keywords

💡Physical examination

Physical examination refers to the process of assessing a patient's health by using observation, palpation, percussion, and auscultation. In the context of the video, it is specifically about the examination of the chest as it relates to the cardiovascular system, which is essential for identifying any abnormalities in heart function.

💡Cardiovascular system

The cardiovascular system is responsible for circulating blood throughout the body, delivering oxygen and nutrients to tissues and organs. The video discusses the examination of the cardiovascular system through various techniques, emphasizing its importance in diagnosing heart-related conditions.

💡Palpation

Palpation is a diagnostic method involving the use of touch to assess the condition of organs and tissues. In the video, palpation is mentioned as a way to confirm visual observations, such as the detection of heart beats or 'thrills,' which can indicate underlying heart conditions.

💡Percussion

Percussion is a technique used in physical examination where the clinician taps on the body surface to assess the underlying structures. The video mentions percussion as a method to evaluate the chest, particularly to identify the presence of a dilated heart chamber or pericardial effusion.

💡Auscultation

Auscultation involves listening to sounds within the body, typically using a stethoscope, to identify normal or abnormal sounds. Although not explicitly mentioned in the script, it is implied as a part of the physical examination process, especially when discussing the identification of heart murmurs.

💡Apex beat

The apex beat, or 'choque de la punta' in Spanish, is the point of maximum impulse of the heart during systole. The video describes its normal location and how its displacement can indicate pathological conditions such as left ventricular enlargement.

💡Cardiac hypertrophy

Cardiac hypertrophy refers to the thickening of the heart muscle, often in response to increased workload or pressure. The video explains how the intensity and location of the apex beat can suggest hypertrophy of either the left or right ventricle.

💡Heart murmurs

Heart murmurs are abnormal sounds heard during auscultation, caused by turbulent blood flow through the heart. The script implies that the presence of a thrill, or palpable murmur, is indicative of organic heart disease and can help in the classification of heart murmurs.

💡Pulmonary hypertension

Pulmonary hypertension is a condition characterized by high blood pressure in the arteries of the lungs. The video mentions it in relation to certain heart beats and murmurs that can be indicative of this condition, such as the 'triad of Chávez'.

💡Ventricular enlargement

Ventricular enlargement refers to an increase in the size of the heart's ventricles, which can be a result of various heart diseases. The video discusses how the examination of the chest can reveal signs of left or right ventricular enlargement, such as displacement of the apex beat.

💡Thrill

A thrill is a palpable, vibrating sensation that can be felt over the heart or other areas of the body, often associated with heart murmurs. The video script describes the importance of thrill in confirming the presence of a cardiac murmur and its significance in diagnosing heart conditions.

Highlights

Physical examination of the thorax in relation to the cardiovascular system begins with inspection and continues with palpation.

Palpation is usually done simultaneously to confirm what is seen during inspection.

Percussion is followed by auscultation for the examination of the thorax.

It is advisable to position oneself to the right of the patient for a transversal observation angle.

Observation of precordial movements corresponding to heartbeats is essential.

Palpation is used to evaluate the precordial movements, particularly in young individuals under 40 years old.

The apical impulse, a type of heartbeat, is normally observed in the fifth intercostal space within the clavicular line.

Presence of the apical impulse above the age of 40 may indicate pathological characteristics.

Fundamental modifications of the apical impulse include changes in location and intensity.

An intense and sustained apical impulse may indicate hypertrophy of the left ventricle.

A brief but extensive apical impulse deviated to the left may correspond to volume overload of the left ventricle.

Palpation can confirm visual observations by approaching the patient's thorax from the right side.

The right parasternal impulse is indicative of the right ventricle's enlargement and hypertrophy.

The second left parasternal impulse in the area of the pulmonary artery can be palpated and percussed.

The presence of the right parasternal impulse is always pathological.

Percussion of the precordial area can identify a dilated right ventricle or pericardial effusion.

Palpation can detect phenomena such as thrills and valvular vibrations.

The Rivero Carvalho maneuver helps determine whether a palpable impulse is from the abdominal aorta or the right ventricle.

Transcripts

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