M1 H&P: Cardiovascular

Devin Nickol, M.D.

I. Overview: Examining the Heart and Great Vessels

- Inspection

- Palpation

- Auscultation

- Percussion?

 

II. Inspection

- Examine patient both ___________ and sitting up

- Tangential light helps

- Look for _________ and “heaves”

- It is normal to be able to see the apex pulsate in a sitting patient, and this can give an idea of cardiac size

- The normal location for the apex is ICS ____ in the __________________________ line

- Assess the jugular venous pulse

 

III. Palpation

- Palpate the _____________________________________________ (PMI) and note its location

- Palpate for thrills

- Palpate the carotid pulse and note its intensity, duration, and timing relative to the PMI

- Palpate the following arteries: brachial, radial, femoral, popliteal, dorsalis pedis, posterior tibial

 

IV. Auscultation

- Listen for bruits with the ____________ over the carotid, aortic and renal arteries

- Listen with both the bell and the diaphragm over the four main anatomic locations for a long time

- Listen for the first heart sound (aka _________ ) and determine if it is split or single

- Listen for the second heart sound (aka _________ ) and determine if it is split or single

- Listen to systole and diastole for extra sounds

- Identify an S3 or S4 if present

- Murmur Intensity:

Grade I: Barely audible in a quiet room

Grade II: Louder than grade I, but still soft

Grade III: A loud murmur

Grade IV: A loud murmur with a ______________

Grade V: Audible with just the edge of the stethoscope touching the chest, thrill easily palpable

Grade VI: Audible with stethoscope off the chest, visible and palpable thrill

 

V. Putting It All Together: Describing Murmurs

- When does the murmur occur?

- What does it sound like?

- Intensity?

- Where is it best heard?

- Radiation?

Example: A harsh, grade III/VI midsystolic murmur best heard over the apex, with radiation to the axilla.