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
Auscultation Pericardium Mitral area = Apex beat Aortic area Tricuspid area Pulmonary area Axilla Carotid
Maneuver for aortic regurgitation
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 ?
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 ?
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)
Back Palpate for sacral edema Auscultate lung bases