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CVS Physical Examination Hadeel Khadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-Qura University.

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Presentation on theme: "CVS Physical Examination Hadeel Khadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-Qura University."— Presentation transcript:

1 CVS Physical Examination Hadeel Khadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-Qura University

2 General Approach Vital Signs Position 45

3 Peripheral Exam Pericardium Exam  Hand  Wrist + Arm  Face  Neck  Inspection  Palpation  Auscultation CVS Exam

4 Hand Nail Dorsum Palm

5 Nail  Clubbing  Peripheral Cyanosis  Splinter Hemorrhage What are the causes of clubbing? Hand

6 Dorsum  Muscle Wasting  Tendons xanthomata Hand

7 Palm  Osler’s Nodules  Janeway Nodules  Palmer Xanthomata Hand

8 Wrist + Arm Radial Pulse  Rate  Rhythm  Volume  Character  Radio-radial delay  Radio-femoral delay Blood Pressure What are the different characters of arterial pulses ?

9 Face Eyes Cheeks Mouth

10 Face Eye  Jaundice  Pallor  Xanthelasma

11 Face Cheeks  Mitral Face

12 Face Mouth  Peripheral cyanosis  Central cyanosis  Jaundice  Infected teeth  High arch palate

13 Neck  Carotid Pulse  JVP

14 Pericardium Inspection  Scar  Skeletal Deformity  Visible Apex Beat

15 Palpation  Apex Beat - Site - Size - Character  Heave  Thrill What can you do if you couldn’t feel the apex beat? What are the possible causes of difficult apex beat palpation? What are the different characters of apex beat? Pericardium

16 Auscultation Pericardium Mitral area = Apex beat Aortic area Tricuspid area Pulmonary area Axilla Carotid

17 Maneuver for aortic regurgitation

18 How to present your findings: S1 & S2 Splitting of S2 Added sounds Murmur What are the causes of loud S1 & S2 ? What are the causes of soft S1 & S2 ? What are the causes of wide, fixed & reversed splitting of S2 ? What are the causes of S3 & S4 ?

19 How to present a sound of murmur :  Timing  Sub timing  Radiation  Grade  Area of greatest intensity What are the timing and sub timing of cardiac murmurs ?

20 Dynamic Maneuver All murmur increase with increases of venous return Except in HOCM & MVP  Squatting to standing  Standing to squatting  Valsalva maneuver  Respiration: Inspiration Expiration  Isometric exercise (hand grip)

21 Back  Palpate for sacral edema  Auscultate lung bases

22 Abdomen  Enlarged liver  Ascites  Splenomegaly  Aortic aneurysm

23 Lower Limbs  Pulses: - Femoral - Popliteal - Posterior tibial - Dorsalis pedis  Pitting edema  Achilles tendon xanthomata  Signs of PVD  Signs of DVT

24 Always Love by your heart not by your mind...


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