Cardiovascular Exam

Summary

This video script offers a comprehensive guide to the basics of the cardiovascular examination. It emphasizes the importance of cleanliness, consent, and observation for signs of cardiovascular disease. The tutorial covers pulse and blood pressure measurement, palpation of the apex beat, and the identification of heart sounds and murmurs. It also highlights the need for a respiratory and abdominal exam, along with a patient's history, to complete the assessment. The script concludes with the reminder to perform an ECG and the importance of patient care.

Takeaways

• 🧼 Always start with clean hands and obtain patient consent before the examination.
• 👀 Observe the patient from a distance for any signs of pain, discomfort, or restfulness.
• 🤲 Check the hands for peripheral signs of cardiovascular disease and palpate the radial pulse.
• 🌡 Measure blood pressure using a sphygmomanometer and look for signs of anemia or hypoxia in the patient's face.
• 🔍 In the neck, feel for the carotid pulse and remember not to palpate both carotid arteries simultaneously.
• 📏 Measure the jugular venous pressure (JVP) to assess right heart function.
• 👣 Examine the chest for scars, deformities, or signs of pacemakers, and palpate for the apex beat to gauge heart size and location.
• 🤲 Feel for heaves and thrills to identify potential hypertrophy or valve issues.
• 👂 Use the stethoscope to listen for heart sounds, starting at the apex with the bell, then the diaphragm.
• 🌟 Listen over various areas of the chest to identify heart murmurs and other abnormal sounds.
• 🛑 Check for signs of pulmonary congestion by listening for crackles in the lung bases when the patient leans forward.
• 👣 Assess for peripheral edema by pressing over the sacrum and checking for indentation and pedal edema.
• 📝 A complete cardiovascular exam also includes a respiratory and abdominal exam, a full patient history, and an ECG.

Q & A

What are the preliminary steps to take before starting a cardiovascular examination?

Before starting a cardiovascular examination, ensure to clean your hands and obtain the patient's consent.

Why is it important to observe the patient's comfort level at rest during the cardiovascular examination?

Observing the patient's comfort level at rest helps identify any obvious pain or discomfort that may be indicative of underlying cardiovascular issues.

What peripheral signs of cardiovascular disease should one look for in the patient's hands?

One should look for signs such as clubbing of fingers, which can be indicative of heart or lung issues.

How should blood pressure be measured during a cardiovascular examination?

Blood pressure should be measured using a sphygmomanometer, which is a device that measures arterial blood pressure.

What does the presence of a palpable apical beat suggest about the patient's heart condition?

A palpable apical beat may suggest that the heart is enlarged or that there is left ventricular hypertrophy.

What is the significance of feeling for heaves and thrills during the chest examination?

Heaves indicate the presence of an enlarged heart, often due to hypertrophy, while thrills are palpable vibrations that can be associated with abnormal heart sounds or murmurs, often due to valve issues.

Why is it important to listen for the first two heart sounds and any extra sounds with a stethoscope?

Listening for the first two heart sounds and any extra sounds helps in identifying normal heart function and detecting any abnormalities such as heart murmurs or irregular rhythms.

What is the purpose of having the patient lean forward and listening to the back during the examination?

Listening to the back with the patient leaning forward helps in detecting crackles in the lung bases, which can be a sign of pulmonary congestion.

Why is it necessary to press gently over the sacrum and check for an indentation?

Pressing over the sacrum and checking for an indentation helps in identifying sacral edema, which can be a sign of fluid retention and may indicate heart failure.

What additional exams should be performed after a cardiovascular examination to complete the patient's assessment?

After a cardiovascular examination, a respiratory exam, an abdominal exam, and a full patient history should be conducted, along with an ECG to get a comprehensive assessment.

What does the acronym 'JVP' stand for and why is it measured during a cardiovascular examination?

JVP stands for Jugular Venous Pressure. It is measured to assess the right-sided filling pressure of the heart and can provide clues about the heart's function and the presence of heart failure.