Lecture 4 cv Flashcards
CARDIOVASCULAR PHYSICAL EXAMINATION
- INSPECTION
- PALPATION
- PERCUSSION
- AUSCULTATION
INSPECTION
GENERAL INSPECTION
INSPECTION OF THE ANTERIOR THORAX.
GENERAL INSPECTION
- HEIGHT , WEIGHT => NUTRITIONAL STATUS
- FACIES
- CONSTITUTIONAL TYPE
- PSYCHIC STATUS
- SPEAKING
- DECUBITUS
- OTRHOSTATISM AND WALKING
INSPECTION
EXAMINATION OF SKIN, MUCOSAE AND
SUBCUTANEOUS TISSUE.
- CYANOSIS
- PALOR
- TELEANGIECTASIS
- JAUNDICE
- NAILS
- ERITEMA
- FINGERS
- CARDIOVASCULAR
INSPECTION
INSPECTION OF THE ANTERIOR THORACIC
REGION
- INSPECTION OF THE ANTERIOR VERVICAL REGION. - INSPECTION OF THE PRECORDIAL REGION - INSPECTION OF THE RIGHT THORACIC REGION AND OF THE INFERIOR STERNAL REGION.
INSPECTION
PERIODS
- STATIC
- DYNAMIC
INSPECTION OF THE ANTERIOR CERVICAL REGION
- CAROTID PULSATION (ARTERIAL DANCE)
- JUGULAR PULSATION
- JUGULAR TURGOR
- AORTIC PULSATION
INSPECTION OF THE PRECORDIAL REGION
- VISIBLE APICAL IMPULSE
- LEFT VENTRICULAR ANURYSM
- AORTIC ANEURYSM
INSPECTION OF THE RIGHT HEMITHORAX AND STERNAL REGION
- AORTIC ANEURYSM
- LIVER PULSATIONS
- RIGHT VENTRICULAR IMPULSE
PALPATION
- ANTERIOR CERVICAL REGION
- STERNAL NOTCH
- APICAL IMPULSE
- MEZOCARDIAC REGION
- AUSCULTATION AREAS
- IRRADIATION AREAS
- EPIGASTRIC REGION
PALPATION
APICAL IMPULSE
- LOCATION
- SURFACE
- AMPLITUDE
- UNICITY
- RITHMICITY
PALPATION
AREAS- FOCI
- CARDIAC SOUNDS EQUIVALENTS
- THRILLS –palpable vibrations from murmurs or
bruits- grade 4/6 or louder. - PERICARDIAL RUB.
PERCUSSION
2 MOMENTS
- SUPERFICIAL
- DEEP.
LOCATION OF THE CARDIAC DULLNESS -> RELATIVE
ABSOLUTE
PERCUSSION
RV -> RIGHT EDGE OF THE STERNUM III – VI IC.
-> DOWNWARDS INCREASED DULLNESS
LV -> POSTERIOR PERCUSSION
AO -> RIGHT EDGE. SP II – III IC.
PA -> SP III IC. LEFT.
CARDIAC AUSCULTATION
DIRECT CORRELATION BETWEEN
HEMODYNAMIC PHENOMENA – ACOUSTIC
PHENOMENA = ACURACY OF THE CONCLUSION
PRACTICABLE IN ANY CONDITIONS
C. A. => DIRECT (IMEDIATE)
INDIRECT (MEDIATE)
BIAURICULAR STHETOSCOPE
- AURICULAR PIECE: COMFORTABLE
- TUBES: 25 – 30cm, lumen ≥ 3mm
- CHEST PIECE: FLAT RESPONSE CURVE FOR: 50 – 1200 Hz
TECHNIQUE
- QUIET ROOM
WE LISTEN FOR
1. LOW FREQUENCIES
2. HIGH FREQUENCIES
- COMFORTABLE POSITION
- PACIENT IN DORSAL DECUBITUS
- SPECIFIC MANOEUVRES
- ORTHOSTATISM
AUSCOULTAION FOCI(AREAS)
LOOK AT THE PRESENTATION
– – TUM – TA – – TUM – TA – –
SOUND I
FREQUENCY — VARIABLE
RHYTHMICITY — VARIABLE
INTENSITY — INTENSE
PITCH — LOWER
DURATION — LONGER
DELIMITATION — LESS CLEAR
AUDIBILITY — MITRAL AREA
SOUND II
FRECUENCY — VARIABLE
RHYTHMICITY — VARIABLE
INTENSITY — LESS INTENSE
PITCH — HIGHER
DURATION — SHORTER
LIMITS — CLEAR
AUDIBILITY — BASE OF THE HEART.
HEART SOUNDS
TAKE A LOOK AT SLIDE 22
CONCOMITANT
DIMINUATION
ENHANCEMENT
SEPPARATE
DIMINUATION
ENHANCEMENT
VARIABLE
SPLITTING
CHANGES IN HEART SOUNDS
DIMINUATION
EMPHYSEMA
OBESITY
EXTREME TACHY
CHANGES IN HEART SOUNDS
ENHANCEMENT
- “FETAL RHYTHM”
- CARDIOGENIC SHOCK
- RHEUMATIC FEVER (initial)
CHANGES IN HEART SOUNDS
_______ —–>
- CHILDREN
- HYPERKINETIC status.
- hypertension
- —->
- RHEUMATIC FEVER(late)
CHANGES IN SOUND I
SOUND I INTENSITY IS DETERMINED BY:
- POSITION OF THE CUSPS.
- VALVULAR INTRINSIC MOBILITY.
- LV CONTRACTION VELOCITY
- MITRAL VALVE COMPLETE CLOSURE.
- OTHER BIOLOGICAL AND PHYSICAL CHARACTERISTICS OF THE VALVES.
ENHANCEMENT OF SOUND I
EHANCEMENT
- NONCALCIFIED MITRAL STENOSIS.
- SCLEROUS VALVES.
SOUND I DIMINUATION
TAKE A LOOK AT SLIDE 27 ,28
Changes in sound I
VARIABLE S I
——>
SPLITTING OF S I
- ATRIAL FIBRILLATION
- —–>
- AV DISSOCIATION.
1 .MITRAL component
- – TRICUSPID component
PHYSIOLOGIC
PATHOLOGIC
− RBBB,LBBB
− idioventricular rythm
Intensity changes for Sound II
S II formed of - II A - II P ENHANCEMENT - PHYSIOLOGIC – pulmonary area (↑ in inspiration) - PATHOLOGIC
AORTIC AREA (CLANGOR)
- hypertension
- AORTIC ATHEROMA
PULMONARY AREA (pulmonary hypertension)
- MITRAL STENOSIS
- COR PULMONARE (±)
- Primary pulmonary hypertension
- Congenital heart disease
- Interatrial septal defect.
CHANGES IN INTENSITY-SOUND II
DIMINUATION
AORTIC area
- hypotension
- SHOCK
- AORTIC REGURGITATION
- AORTIC STENOSIS, CALCIFIED
Pulmonary area
- PULMONARY VALVULAR STENOSIS
CHANGES IN INTENSITY-SOUND II
SPLITTING
SPLITTING
> PHYSIOLOGICAL - ONLY in the pulmonary area in INSPIRATION.
> PATHOLOGIC
LARGE SPLITTING
- RBBB.
- PULMONARY VALVULAR STENOSIS
- MITRAL REGURGITATION
FIXED SPLITTING (NO change in inspiration)
- ATRIAL SEPTAL DEFECT
REVERSED SPLITTING
- LBBB
- AORTIC STENOSIS
THREE STROKE CARDIAC RHYTHM
- PHYSIOLOGIC - S III physiologic
- PATHOLOGIC
- SPLITTING of SI
- SPLITTING of SII
- CLICKS
- PROTOSYSTOLIC
–>AORTIC
PULMONAR - MEZOTELESYSTOLIC
- IZODIASTOLIC
- MITRAL VALVE OPENING.
- PROTOSYSTOLIC
- GALOPURI
CLICKS
PPROTOSYSTOLIC CLICK
PPROTOSYSTOLIC CLICK
- Short, snaped , ejectional click
- Large psudosplitting of SI = SI + click
AORTIC
- it can be listened in the mitral area.
- no obvious respiratory variation
- Noncalcified AS – aortic sclerosis.
- AR sometimes.
PULMONARY pulmonary area disappearance in inspiration. - LARGE PS - PAH - MS
CLICKS
MESOTELESYSTOLIC CLICK
MESOTELESYSTOLIC CLICK
- LARGE INTENSITY
- SHORT
- SNAPED
in PRIMARY VALVULAR MITRAL PROLAPSE
- VIBRANT
- SUPERFICIAL
- Also called – triolet sound.
CLICKS
ISODIASTOLIC CLICK
ISODIASTOLIC CLICK
- LARGE INTENSITY
- SHORT
- HIGH PITCH
- IT HAPPENS “UNDER THE EAR”
- MAXIMAL INTENSITY –LOWER STERNUM in CONSTRICTIVE PERICARDITIS.
CLICKS
MITRAL OPENING CLICK (TRICUSP)
MITRAL OPENING CLICK (TRICUSP)
- LARGE INTENSITY
- SHORT
- IT IS PERCEIVED AT A DEFINITE DISTANCE FROM SII.
- BETTER HEARD AT THE APEX AND LOWER STERNUM
- CHARACTERISTIC FOR MS WITH NONCLCIFIED VALVES.
- IN MS, MITRAL DISEASE , MR (RARE)
GALLOPS
- PATHOLOGICAL SOUNDS
- ONLY IN DIASTOLE
- LOW PITCH
- LOW INTENSITY
- DULL ARMONICS.
GALLOPS
LEFT
RIGHT
- PRESYSTOLIC
- PROTODIASTOLIC
- SUMMATION
GALLOPS
PRESYSTOLIC = S IV PATHOLOGIC
PRESYSTOLIC = S IV PATHOLOGIC
- CONNECTED TO THE ATRIAL SYSTOLE
- SIGN OF DIASTOLIC LV DYSFUNCTION-elevated filling pressure.
- CAUSES:
1. HYPERTENSION
2. LEFT VENTRICULAR HYPETROPHY
3. CAD
4. AMI
5. HYPERTROPHIC CARDIOMYOPATHY concentric
6. Severe Aortic Stenosis
7. Third degree AV block.
GALLOPS
PROTODIASTOLIC = S III pathologic
PROTODIASTOLIC = S III pathologic
> Ventricular gallop
> SVERE LEFT VENTRICULAR DYSFUNCTION.
> PROGNOSIS ( 4 – 5 YEARS)
> CAUSES:
- CAD
- HYPERTENSION
- DILATED CARDIOMYOPATHIES
- EXCENTRIC HYPERTROPHIC
- CARDIOMYOPATHY.GALLOPS
MESODIASTOLIC = SUMMATION
MESODIASTOLIC = SUMMATION
- SUM OF THE S3 AND S4.
- TACHYCARDIA
- GRADE I AV BLOCK.
RIGHT.
- LOWER EXTREMITY OF THE STERNUM
- ENHANCED IN POSTINSPIRATORY APNEEA.
