Narrator: : A good cardiovascular examination requires more than observation. You must think about the possible meanings of your individuals observations, fit them together in a logical pattern, and correlate your cardiac findings with the patient’s blood pressure, arterial pulses, jugular venous pulsations, the rest of your head to toe examination, and the patient’s history.
With the patient supine, begin the cardiac examination. One of the most important and frequently used skills of physical examination and often the first step of your cardiovascular assessment is estimating the jugular venous pressure, or JVP. In the beginning this will seem difficult, but with time you will find that the JVP provides valuable information about the patient’s volume status and cardiac function.
The usual starting point for assessing the JVP is to ensure that the head of the examination table or bed is elevated to 30 degrees. Be sure to distinguish the undulating jugular wave form from carotid artery pulsations. The steps for measuring the JVP, when followed carefully, result in a measurement that is accurate and useful.
Next, assess the carotid pulse. Your assessment will include both palpation and listening for bruits. Inspect and palpate the anterior chest for any heaves, lifts, or thrills. Then palpate left and right 2nd interspaces close to the sternum. Feel for a right ventricular pulse in the left parasternal and epigastric areas. Note any thrills in these areas. Identify the apical impulse, noting the location, diameter, amplitude, and duration.
Auscultation of heart sounds and murmurs is an important skill that leads directly to several clinical diagnoses. Therefore, it’s important to know your stethoscope, particularly the effective uses of the diaphragm and the bell. Listen with the diaphragm of the stethoscope at the aortic area in the 2nd right interspace. Listen at all auscultory areas for S1, S2, or any murmurs or extra sounds.
Next, roll the patient partly onto the left side and use the bell to detect diastolic sounds such as mitral stenosis, or NS3. Then, with the patient seated and leaning forward, listen along the left sternal border and at the apex for the soft decrescendo diastolic murmur of aortic insufficiency.
Lynn Bickley: Very good. And just lie back for me.