Cardiac Physical Exam

Introduction

The cardiac physical exam is a key component of diagnosing and assessing heart health. It provides valuable insights into heart function, potential valve disorders, heart failure, and other cardiovascular diseases without the need for advanced imaging.

Key Components of the Cardiac Exam

1. General Inspection

  • Assess the patient's general appearance, breathing pattern, and skin color (pale or bluish skin may indicate poor circulation).
  • Look for signs of heart disease such as jugular venous distension (JVD), which may indicate right heart failure.

2. Palpation (Touch Examination)

  • Point of Maximal Impulse (PMI): The PMI is normally located at the left 5th intercostal space, mid-clavicular line. A displaced PMI may indicate an enlarged heart.
  • Pulses: Assess the radial, carotid, and femoral pulses for rate, rhythm, and regularity.
  • Thrills: A palpable vibration may indicate a significant heart murmur.

3. Percussion

  • Percussion is less commonly used today but can help estimate heart size by detecting dullness over the heart area.

4. Auscultation (Listening with a Stethoscope)

  • Heart Sounds:
    • S1 (Lub): Closure of the mitral and tricuspid valves.
    • S2 (Dub): Closure of the aortic and pulmonary valves.
    • Additional sounds (S3 and S4) may indicate heart failure or stiff ventricles.
  • Murmurs: Abnormal sounds caused by turbulent blood flow through the heart, which could indicate valve disease.
  • Rub: A pericardial friction rub may suggest pericarditis.

5. Blood Pressure and Pulse Evaluation

  • Blood Pressure: Both arms should be checked; a significant difference may suggest vascular disease.
  • Pulse Deficit: A difference between apical and radial pulse suggests atrial fibrillation.

Conclusion

A thorough cardiac physical exam is a vital tool for detecting early signs of heart disease and guiding further diagnostic tests. If abnormalities are detected, further investigations such as ECG, echocardiography, or stress tests may be required.

Source recommendations

1. American Heart Association Guidelines for Cardiovascular Examination

  1. https://elearning.heart.org/course/437
  2. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/heart-health-screenings
  3. https://professional.heart.org/en/guidelines-and-statements
  4. https://atlas.heart.org/
  5. https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

2. European Society of Cardiology Guidelines on Cardiovascular Examination

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/ESC-Guidelines-on-non-cardiac-surgery-cardiovascular-assessment-and-managem
  2. https://academic.oup.com/eurheartj/article/43/39/3826/6675076
  3. https://pubmed.ncbi.nlm.nih.gov/36017553/
  4. https://academic.oup.com/eurheartj/article/35/35/2383/425095
  5. https://pubmed.ncbi.nlm.nih.gov/25086026/

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