Cardiovascular System Examination — General OmpathStudy

Continued from $1. Topic 3: General Examination of the Cardiovascular System Objectives At the end of the lesson the learner will be able to: - 1) Perform general examination of the cardiovascular system 1.0 Introduction - Physical Signs of Cardiovascular Disease The approach will depend on the general condition of the patient. The Cardiovascular triage divides patients into 3 groups namely¨- 1) Patients with cardiac/respiratory arrest requiring resuscitation. 2) Severely ill patients who require immediate treatment. 3) Patients who are haemodynamically stable. In stable patients use the figures of ‘1’ inverted “J”, in the very ill and unstable patients the examination procedure will be variable while severely ill patients have to be resuscitated to stabilize. 2.0 Outline of Examination The examination is divided into:- 1) General inspection 2) Examination of arteries 3) Examination of veins 4) Examination of the heart – inspection, palpation, percussion and auscultation 5) Fundoscopic examination 3.0 Scheme for Cardiovascular system examination 1) General impression of the patient Look for cyanosis, signs of respiratory distress and signs of anxiety Observe for excessive breathlessness 2) The Hands Check for warmth and sweating Assess the peripheral circulation Look for finger clubbing and splinter haemorrhages Peripheral cyanosis 3) Palpate the radial pulse, take the pulse rate and assess the rhythm, assess radial-radial delay and radio-femoral delay 4) Palpate the brachial pulse, assess the quality and take blood pressure 5) The Neck Palpate the carotid pulse and listen for bruits Assess the jugular venous pressure (JVP) 6) Examine the face Pallor or polycythaemia Examine the tongue for cyanosis Check for features of dehydration 7) Examine the chest/precordium a. Assess the cardiac impulse b. Locate the apex beat c. Auscultate the heart d. Examine the back of chest - listen for crepitation 8) Look for sacral oedema 9) Examine the abdomen a. Palpate the liver b. Look for renal enlargement c. Look for aortic aneurysms d. Listen for renal bruits 10)Assess the femoral pulses and check for radio-femoral delay 11)Examine the legs a. Palpate the pulses – posterior tibial and dorsalis pedis b. Assess oedema c. Feel the local temperature 12)Examine the optic fundi 4.0 Position of the patient in CVS Examination 5.0 General Examination 5.1. General Inspection 1) Features of Dyspnoea/distress including cyanosis, restlessness, sweating and use of accessory muscles of respiration 2) Deformities e.g. Kyphoscoliosis, Marfan’s syndrome - long tappering fingers with webbing associated with ASD, Myocardial disease, heart valve problem; Turner’s syndrome - associated with pulmonary stenosis and co-arctication of the aorta 3) Breathlessness (shortness of breath) Causes Area Examples 1. Generalize Obesity, Anaemia d Hypertension disorders 2. Respirator Airway obstruction e.g. chronic bronchitis, bronchial asthma, y emphysema, inhaled foreign body Reduced lung compliance e.g. pulmonary oedema, fibrosis, lung infiltration(Ca bronchus, Ca trachea), pneumonia, pleural effusion 3. Cardiac Pulmonary embolism, increased left atrial pressure and increased pulmonary venous pressure 4. Deformitie Chest deformities can impair the functioning of the heart and the s lungs 5.2. The Hands The hands may provide important signs to suggest cardiac disease. For example warm hands suggest vasodilatation, cold hands suggest vasoconstriction. Other features include finger clubbing, splinter haemorrhages, cyanosis, pallor, Janeway lesions and Osler’s nodes. 5.2.1. Pallor [see general examination] Examine for pallor and features of anaemia. The sites include the tongue, conjunctiva, palms/soles and nail beds (capillary re-fill test). Anaemia compromises the functioning of the cardiovascular system and body systems generally Establish the causes of the anaemia which broadly include:-excess acute blood loss, chronic blood loss, dietary insufficiency and excessive destruction of red blood cells(haemolysis) 5.2.2. Cyanosis[see general examination] Cyanosis is the bluish discoloration of the skin and mucous membrane due to excessive amount deoxygenated blood due to reduced haemoglobin in circulation. It is evident clinically when 5gm% of the Hb is deoxygenated (30%) Is of considerable diagnostic valve in certain forms of heart disease e.g. mitral stenosis and pulmonary arterial hypertension Sites include the oral mucosa, lips, extremities (fingers, toes), nose and ears Classification of cyanosis – peripheral and central cyanosis; methemoglbininemia, sulphaemoglobinaemia(abnormal pigments) Peripheral Cyanosis Is due to diminished capillary blood flow allowing more times for oxygen removal by the tissues and arterial partial pressure of oxygen is normal Pulses are weak or impalpable Hands and feet are cyanosed due to cold or poor circulation Causes 1) Low cardiac output e.g. in mitral stenosis (Ms with severe pulmonary hypertension) “Malar flush” and shock