Cardiovascular

General Inspection / Done
perfectly / poor / Not
done / mark
hands and fingers-clubbing
Face-cyanosis
Legs-edema
Chest
Jugular vein
-Recall that jugular veins reflect right atrial pressure
-Steps for examination
Raise the head of the bed or examining table to 30°
Turn the patient’s head gently to side
Identify the topmost point of the flickering venous pulsations
Place a centimeter ruler upright on the sternal angle
Place a card or tongue blade horizontally from the top of the JVP to the ruler, making a right angle
Measure the distance above the sternal angle in centimeters: a 3- to 4-centimeter elevation is normal /
Palpation / Done
perfectly / poor / Not
done / mark
Radial artery- regular or irregular
Carotid artery
Aortic area at the second right ICS(intercostal space)
-palpate for thrills by using the ball of the hand /
Pulmonic area at the second left ICS
-palpate for thrills by using the ball of the hand
Erb’s point, third left ICS
-palpate for thrills by using the ball of the hand
Tricuspid area, fourth left ICS
-palpate for thrills by using the ball of the hand
Apex at the left fifth ICS at the midclavicular line
-palpate for thrills
Percussion / Done
perfectly / poor / Not
done / mark
Cardiac border (Dullness: 3rd-5th ICS)
Auscultation / Done
perfectly / poor / Not
done / mark
Blood pressure measurement
Carotid arteries using the diaphragm and bell for any bruits
Aortic area at the second right ICS(intercostal space)
-by using diaphragm
-S2 is louder than S1 (S1: lub, S2: dub) /
Pulmonic area at the second left ICS
-by using diaphragm
-S2 is louder than S1
Erb’s point, third left ICS
-by using diaphragm
–S1 and S2 are heard equally
Tricuspid area, fourth left ICS
-by using diaphragm
–S1 is louder than S2
Apex at the left fifth ICS at the midclavicular line
-by using diaphragm
–S1 is louder than S2
With the bell of the stethoscope at each of the five areas on the precordium, auscultates for S3 and S4, or murmurs

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