Cardiovascular Physical Exam

Introduction

The cardiovascular physical exam is a crucial part of evaluating heart health. It helps doctors detect heart diseases, such as hypertension, heart failure, and valvular disorders. This exam involves inspecting, palpating, and auscultating different regions of the chest and assessing circulation.

Key Components

1. Inspection

  • Observe for signs of cyanosis (bluish skin), pallor (pale skin), or edema (swelling in the legs and feet).
  • Check for visible pulsations in the neck and chest that may indicate abnormal heart activity.

2. Palpation

  • Feel for a point of maximal impulse (PMI) – normally at the fifth intercostal space, midclavicular line.
  • Assess for thrills (palpable vibrations suggestive of turbulent blood flow due to valve abnormalities).
  • Check peripheral pulses (radial, femoral, dorsalis pedis) to evaluate circulation and symmetry.

3. Auscultation (Listening to Heart Sounds)

  • Use a stethoscope to listen to heart sounds in four key areas:
    • Aortic area: Right 2nd intercostal space.
    • Pulmonic area: Left 2nd intercostal space.
    • Tricuspid area: Lower left sternal border.
    • Mitral area: 5th intercostal space, midclavicular line.
  • Identify normal S1 and S2 heart sounds.
  • Detect abnormal sounds like murmurs (indicating valve disorders) or extra heart sounds (S3, S4, common in heart failure).

4. Blood Pressure Measurement

  • High blood pressure may indicate hypertension, increasing risks of stroke and heart disease.
  • Low blood pressure may suggest heart failure or vascular issues.

Conclusion

A thorough cardiovascular physical exam is essential for diagnosing and managing heart diseases early. Regular check-ups allow early intervention, promoting heart health.

Source recommendations

1. American College of Cardiology/American Heart Association Guidelines on Hypertension

  1. https://www.acc.org/Latest-in-Cardiology/Articles/2024/02/05/11/43/2023-ESH-Hypertension-Guideline-Update
  2. https://www.ahajournals.org/doi/10.1161/hyp.0000000000000065
  3. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2017/11/09/11/41/2017-Guideline-for-High-Blood-Pressure-in-Adults
  4. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.054602
  5. https://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017

2. European Society of Cardiology Guidelines on Cardiovascular Disease Prevention

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/CVD-Prevention-Guidelines
  2. https://academic.oup.com/eurheartj/article/42/34/3227/6358713
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/CVD-and-Diabetes-Guidelines
  4. https://pubmed.ncbi.nlm.nih.gov/34458905/
  5. https://www.ahajournals.org/doi/10.1161/cir.0000000000000678

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