Heart

Question 1

Inspection

Answer 1

Undress upper body, can keep bra on
Lie down on table, have headrest lifted to 30deg
Look at face, color (skin, lips), eyes, chest
Can see apex beat on left 5th intercostal space in thin people
Right ventricular pulsations can be seen left parasternal in children and young adults
It is possible that none are visible: overweight or can lift breast

Question 2

Palpation

Answer 2

Supine position
Hand flat with finger parallel to intercostal space
Feel apex beat 5th intercostal space (put 1 finger in 4th and 1 in 5th): cannot be felt in some people. Size beat is only 1 intercostal space. Intensity: strong, normal, weak. Consist of 1 pulsation (no composition). Surface, duration, amplitude
Ask to roll to left side and palpate apex beat again
Feel right ventricle pulsation parasternal 3rd/4th/5th intercostal space. Normal in children and young adult

Question 3

Percussion

Answer 3

Supine position
Start on midaxillary line at 5th intercostal space and move in medial direction. This determines the left heart border
Start with resonance of lung then dullness of heart
Often indicates the border more laterally then it actually is (palpation of apex beat determines border too)

Question 4

Auscultation

Answer 4

Hear the different valves where it is conducted by bones, vessels,etc
Determine HR and rythm: 60-100bpm & regular. Can hear S1 (mitral and tricuspid valve close) and S2 (aortic and pulmonary valve close)
Ausculate:
Erb’s point: 3rd intercostal space (under sternal angle). S1 & S2 same intensity. S1 a bit shorter, followed by carotid artery pulsation.
Right parasternal 2nd intercostal: aortic opening/closing. S2
Left parasternal 2nd intercostal: pulmonary opening/closing s2
Left parasternal 4th/5th intercostal: tricuspid opening/closing s1
Midclavicular 4th/5th interocstal: mtral opening/closing s1

Splitting of each S can be heard, inspiration increase this.

Duration apex beat: roll on left side, palpate apex beat and ausculate at erb’s point. Should not feel the beat more than 1/3 of S1

Question 5

Examination

Answer 5

Inspection
Palpation: Apex beat (supine and rolled on left side), right ventricular pulsation
Percussion: Left heart border
Ausculation

Question 6

CVP

Answer 6

person lies on the table
head rest at 45°, person turn their face away
observe jugular vein
block jugular vein and stroke the vein to empty it
find collapse point (where it is empty)
The collapse point should not be more than 2 to 4cm above the sternal angle