Cardiovascular Exam Lecture Notes

Overview

• Covered sitting and two-point position for cardiovascular exam.
• Techniques to measure Jugular Venous Pressure (JVP).
• Evaluation of peripheral pulses and vessels.

Auscultation of Carotids

• Use the bell for auscultation.
• Position: Patient's chin up.
• Palpate carotid artery gently.
• Listen for bruit:
  • Instruct patient to take a deep breath and hold it.
  • No bruit indicates no carotid obstruction.

Heart Auscultation

• Importance of topical anatomy:
  • Sternal notch, manubrium, sternal angle (Angle of Lewy).
  • Ribs and intercostal spaces for auscultation:
    • 2nd intercostal space: Aortic (right) and Pulmonic (left).
    • 3rd intercostal space: Erb’s point.
    • 5th intercostal space: Tricuspid (left sternal border) and Mitral (midclavicular line).

Technique

• Use diaphragm first, then switch to bell.
• Listening for physiologic split of S2.
• Listening for murmurs, specifically aortic regurgitation at Erb's point with expired breath.
• Valsalva maneuver to detect hypertrophic obstructive cardiomyopathy.

Measuring Jugular Venous Pressure (JVP)

• Position patient at 30 degrees.
• Inspect for pulsations along the path of the right internal jugular.
• Measure from the angle of Louis:
  • Normal JVP < 3 cm.
  • JVD (Jugular Venous Distension) indicates potential heart failure.

Peripheral Vascular Exam

• Palpate peripheral arteries:
  • Carotids, brachials, radials.
  • Mention femorals (not examined).
  • Popliteal, posterior tibialis, dorsalis pedis.
  • Report full and equal pulses bilaterally.

Inspection

• Check nail beds and fingers for cyanosis and clubbing.
• Capillary refill < 2 seconds.
• Inspect and palpate legs for:
  • Edema
  • Hair distribution
  • Skin condition
  • Temperature
  • Variscosities
  • Use back of hands to compare temperature.

Final Assessment

• Summarize with a report:
  • Rate and rhythm are regular without murmurs, gallops, or rubs.
• No gallops heard in left lateral decubitus position.
• No peripheral vascular abnormalities noted.