Cardiovascular Examination

Introduction

The cardiovascular examination is a fundamental component of physical assessment and is crucial for identifying heart and vascular diseases. It involves inspection, palpation, percussion, and auscultation of the heart and vascular system.

Steps of the Cardiovascular Examination

1. General Inspection

  • Observe the patient's general appearance, skin color, and presence of cyanosis or pallor.
  • Look for visible pulsations in the neck and any signs of respiratory distress.

2. Vital Signs

  • Blood Pressure (BP): Measure in both arms; discrepancies >10 mmHg may suggest aortic dissection.
  • Heart Rate & Rhythm: Palpate the radial pulse for rate, rhythm, and volume.
  • Respiratory Rate & Oxygen Saturation: Important for assessing cardiac function.

3. Neck Examination

  • Jugular Venous Pressure (JVP): A raised JVP may indicate heart failure.
  • Carotid pulse assessment: Feel for strength, upstroke, and any bruits with auscultation.

4. Precordial Examination

  • Inspection & Palpation:
    • Look for visible cardiac impulses.
    • Palpate for thrills (vibrations indicating turbulent blood flow, possibly due to a murmur).
    • Identify the apex beat (normally found in the 5th intercostal space at the midclavicular line).

5. Auscultation

  • Heart Sounds:
    • 1st heart sound (S1): Closure of mitral and tricuspid valves.
    • 2nd heart sound (S2): Closure of aortic and pulmonary valves.
    • Identify additional sounds (S3, S4) that may indicate heart failure or other pathology.
  • Murmurs:
    • Characterize based on timing, intensity, pitch, and radiation.
    • Systolic murmurs may indicate aortic stenosis, mitral regurgitation, etc.
    • Diastolic murmurs suggest mitral stenosis, aortic regurgitation, etc.

6. Peripheral Examination

  • Peripheral Pulses: Assess for symmetry, strength, and any impairment.
  • Capillary Refill Time: Delayed refill (>2 seconds) may suggest poor perfusion.
  • Edema: Check for signs of fluid overload (e.g., ankle swelling in heart failure).

Importance of Cardiovascular Exam

This examination helps diagnose various cardiac conditions such as: - Heart failure - Valvular heart disease - Peripheral artery disease - Hypertension-related complications

Conclusion

A thorough cardiovascular examination is essential for detecting heart diseases early and guiding further investigations, such as echocardiography or ECG.

Source recommendations

1. American Heart Association Guidelines for Cardiovascular Assessment

  1. https://professional.heart.org/en/guidelines-and-statements/prevent-calculator
  2. https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8
  3. https://newsroom.heart.org/news/leading-cardiologists-reveal-new-heart-disease-risk-calculator
  4. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/heart-health-screenings
  5. https://pubmed.ncbi.nlm.nih.gov/24222018/

2. European Society of Cardiology Clinical Practice Guidelines

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines
  2. https://academic.oup.com/eurheartj/article/42/34/3227/6358713
  3. https://www.escardio.org/Guidelines
  4. https://pubmed.ncbi.nlm.nih.gov/17726041/
  5. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure

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