1. CVS Examination done by Fahad Gadi 6th year medical student-2007

2. CVS Examination General The praecordium General appearance The hands
The face
The neck
The praecordium
Inspection
Palpation
Auscultation

3. The praecordium Inspection Palpation Auscultation Deformities
Apex beat
Visible pulsations
Scars
Palpation
Parasternal heave
Palpable thrills
Auscultation
Heart sounds
Added sounds
Cardiac murmurs

4. 1.General appearance Look for: (ABCDE) Respiratory distress Cachexia
Dysmorphic features

5. 2.The Hands Clubbing Splinter hemorrhage Osler nodes (tender)
Janway lesions (not tender)

7. 2.The Hands Radial pulse: Condition of the vessel wall Blood pressure
Rate
Rhythm: [regular, irregular (irregularly irregular, regularly irregular)]
Character and volume (collapsing, alternans)
Radiofemoral delay
Radio-radial delay
Condition of the vessel wall
Blood pressure

8. 3.The Face Jaundice Xanthelasma
Mitral features (rosy cheeks, bluish tinge)
Central cyanosis in the tongue

10. 4.The Neck
Palpate the carotid artery medial to sternomastoid muscle for character (bisferience, collapsing, alternans, jerky)
Inspect the height of the JVP by inspecting the internal jugular vein

11. 4.The Neck Jugular pulse can be distinguished from arterial pulse by:
It is a complex wave (flicker twice)
Jugular is visible but not palpable
JVP decreases with inspiration
It is filled from above after removing pressure applied to the base of the neck

13. 5.The Praecordium By INSPECTION: Scars
Skeletal abnormalities (pectus excavatum, kyphoscoliosis)
Apex beat
Other visible pulsations

15. 5.The Praecordium By PALPATION:
Apex beat:
Site (the most lateral and most inferior; normally in the 5th left intercostals space in the mid clavicular line)
Displaced or not
Character (heaving, double impulse, tapping)
Parasternal impulse:
By the heel of the hand rested just to the left of the sternum.
Palpable murmurs (thrills):
Start at the apex then the left sternal edge then the base of the heart.

16. 5.The Praecordium: By AUSCULTATION:
Start in the mitral area with the bell to hear low pitch sounds like in mitral stenosis then use the diaphragm.
Then move to the tricuspid area (5th Lt. intercostal)
Then to pulmonary area (2nd Lt. intercostal)
Then to aortic area (2nd Rt. intercostal)
On auscultation listen to:
Heart sounds (S1, S2)
Abnormalities in heart sounds (loud, soft, increased splitting, fixed splitting, reversed splitting)
Additional sounds (S3, S4)
Heart murmurs

18. What to look for in Murmers
Site
Intensity ( 6 grades )
Time
Duration
Radiation
Special caracter

19. 6.The Back
Percussion and auscultation of the lung bases looking for signs of cardiac failure like:
Crepitation
Pleural effusion
Sacral edema

20. 7.The Abdomen
Look for
Ascitis
Hepatomegaly

21. 8.The Lower limbs Palpate the Then look for lower limb edema.
Femoral artery (below inguinal ligament 1/3 of the way up from the pubic tubercle)
Popliteal artery (behind the knees)
Post. tibial (below medial malleolus half the way between the calcaneus and medial malleolus)
Dorsalis pedis (between the 1st and 2nd metatarsal bone lateral to flexor hallosis longus)
Then look for lower limb edema.

23. THANK YOU