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CVS Physical Examination

CVS Physical Examination . Hadeel Khadawardi , teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al- Qura University. General Approach . Vital Signs . Position . 45. CVS Exam . Pericardium Exam . Peripheral Exam . Inspection Palpation Auscultation . Hand

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CVS Physical Examination

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  1. CVS Physical Examination HadeelKhadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-Qura University

  2. General Approach Vital Signs Position 45

  3. CVS Exam Pericardium Exam Peripheral Exam • Inspection • Palpation • Auscultation • Hand • Wrist + Arm • Face • Neck

  4. Hand Nail Dorsum Palm

  5. Hand • Nail • Clubbing • Peripheral Cyanosis • Splinter Hemorrhage What are the causes of clubbing?

  6. Hand • Dorsum • Muscle Wasting • Tendons xanthomata

  7. Hand • Palm • Osler’s Nodules • Janeway Nodules • Palmer Xanthomata

  8. Wrist + Arm • Radial Pulse • Rate • Rhythm • Volume • Character • Radio-radial delay • Radio-femoral delay • Blood Pressure What are the different characters of arterial pulses ?

  9. Face Eyes Cheeks Mouth

  10. Face • Eye • Jaundice • Pallor • Xanthelasma

  11. Face • Cheeks • Mitral Face

  12. Face • Mouth • Peripheral cyanosis • Central cyanosis • Jaundice • Infected teeth • High arch palate

  13. Neck • Carotid Pulse • JVP

  14. Pericardium • Inspection • Scar • Skeletal Deformity • Visible Apex Beat

  15. Pericardium • Palpation • Apex Beat • - Site • - Size • - Character • Heave • Thrill What can you do if you couldn’t feel the apex beat? What are the possible causes of difficult apex beat palpation? What are the different characters of apex beat?

  16. Pericardium Auscultation Carotid Aortic area Pulmonary area Axilla Tricuspid area Mitral area = Apex beat

  17. Maneuver for aortic regurgitation

  18. How to present your findings: • S1 & S2 • Splitting of S2 • Added sounds • Murmur What are the causes of loud S1 & S2 ? What are the causes of soft S1 & S2 ? What are the causes of wide, fixed & reversed splitting of S2 ? What are the causes of S3 & S4 ?

  19. How to present a sound of murmur: • Timing • Sub timing • Radiation • Grade • Area of greatest intensity What are the timing and sub timing of cardiac murmurs ?

  20. Dynamic Maneuver All murmur increase with increases of venous return Except in HOCM & MVP • Squatting to standing • Standing to squatting • Valsalva maneuver • Respiration: • Inspiration • Expiration • Isometric exercise (hand grip)

  21. Back • Palpate for sacral edema • Auscultate lung bases

  22. Abdomen • Enlarged liver • Ascites • Splenomegaly • Aortic aneurysm

  23. Lower Limbs • Pulses: • - Femoral • - Popliteal • - Posterior tibial • - Dorsalispedis • Pitting edema • Achilles tendon xanthomata • Signs of PVD • Signs of DVT

  24. Always Love by your heart not by your mind ...

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