CLINICAL SKILL LAB

CARDIOVASCULAR SYSTEM

INSPECTION
PALPATION

PERCUSSION
AUSCULTATION

MMP

HOW TO PRECUSS THE HEART

1. Locate midsternal line,r/l sternal line,r/lmcl,left anterior axillary line,posterior axillary line and mid axillary line 2. For the normal size heart Locate the lung-gastric border in the mc line(in the middle of normal respiration),Locate point at 2cm above,lung-gastric border and percuss from lateral left to medial.The point the where sound changing from sonor to dull(this is the Left border of the heart).For a big heart do it from the mid or lateral axillary line 3. Locate the right lung-liver border in the rmcl (in the middle of normal respiration),,Locate 2 cm above,lung-liver border and percuss from lateral right to medial.The the point where the sound change from sonor to dull.(This is the Right border of the heart) 4. Percus from up side to the lower side of the left sternal line The point where the sound change from sonos to dull. is the uppper heart border(up side border) 5. Percuss from the left shoulder to sentral of the heart to judge the Left Atrial/Pulmonal artery enlargement and also from up side down at the para-sternal line. 6. Note:In most case palpation has replaced percussiosion for estimation of cardiac size.If you can not feel the apical impulse,hawever, percussion may suggest where to search it.Occasioally percussion may be your only tool 7. (Sukaton U(Editor).Petunjuk tentang Riwayat Penyakit dan Pemeriksaan Jasmani,Bagian I.P.D FKUI,Jakarta,cetakan ke2,1986. 8. Chizner MA.The Diagnosis of Heart Disease by Clinical Assesment Alone.Current Problems in Cardiology;26:285-380,2001

INTENSITY HEART SOUND

1.Heard by an expert in optimum condition 2.Heard by non-expert in optimum condition 3.Easily heard,no thrill

4.A loud murmur,with a thrill

5.very loud.often heard over wide area with thrill 6.Extreemily loud,heard without sthetoscope

ELECTROCARDIOGRAPHY

12 conventional leads ecg

6 extremity lead,represent frontal plane Bipolar leads(I,II,III) Unipolar(right leg elctrode function as a ground (zero potential),a means augmented 50% leads(aVR,aVL,aVF) I=left arm-right arm voltage II=Left leg-right arm III=left leg-left arm 6 chest precordial lead (v) represent horizontal plane V1:4th IC space right of the sternum V2:4th IC space left to the sternum V3:mid way between V2-V4 V4:IC5,mid clavic line V5:same level as V4 anterior axillary linV6 V6:Mid axillary line same level as V4-V5

ECG Systematic

Rate and Rhythm

Interval(A-V,BBB,QT) and Axis Chamber enlargment(?LAE/RAE;?LVH/RVH) QRST change(Q,PRWP,ST T changes)

Heart Rate 60 100 bpm

Rhythm Regular

P Wave Before each QRS,

PR Interval (in seconds) 0.12 - 0.20

QRS (in seconds) < 0.12