Video 11 Examen del tórax Aparato cardiovascular

Summary

This 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.