Cardiovascular Physical Examination

dr. Muhammad Taufik Ismail, dr. Gagah Buana P

Bagian Jantung dan Pembuluh Darah
Fakultas Kedokteran Universitas Gadjah Mada
Yogyakarta 2015
 OVERVIEW
Anatomy and Physiology
Heart / Precordial Exam
Peripheral Vascular Exam
The Cardiovascular System

Anatomy
and
Physiology
Anatomy and Physiology - Anatomy

1. Inferior vena cava

2. Superior vena cava
3. Right atrium
4. Tricuspid valve
5. Right ventricle
6. Pulmonic valve
7. Pulmonic branch
8. Pulmonary arteries
9. Pulmonary veins
10. Left atrium
11.Mitral valve
12.Left ventricle
13.Aortic valve
14.Aorta
15.Brachiocephalic artery
Anatomy and Physiology Surface projection of the Heart

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Anatomy and Physiology Chambers, Valves, Circulation

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Anatomy and Physiology Cardiac cycle

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Anatomy and Physiology Cardiac cycle & Heart Sounds

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Anatomy and Physiology Cardiac cycle & Heart Sounds

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The Cardiovascular System

Heart /
Precordial
Exam
Heart / Precordial Exam General Preparation

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Heart / Precordial Exam The Sequence

1st SUPINE

2nd TURN

3rd SUPINE

4th SITTING
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Heart / Precordial Exam - Inspection

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Heart / Precordial Exam - Palpation

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Heart / Precordial Exam - Palpation

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Heart / Precordial Exam - Percussion

Percussion of the heart area is not done on routine precordial

routine
exams. precordial exams.
In most cases, In mosthas
palpation cases,
replaced percussion in the
estimation of cardiac size.
When you cannot feel the apical impulse,
however, percussion may suggest where to
search for it.
However, it can be useful with certain
conditions.
Dullness is increased with a pericardial effusion.
Dullness is decreased in COPD.

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Heart / Precordial Exam Percussion & Auscultation

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Heart / Precordial Exam - Auscultation

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Heart / Precordial Exam - Auscultation

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Heart / Precordial Exam - Auscultation

Where to listen?

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Heart / Precordial Exam

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Heart / Precordial Exam - Auscultation

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Heart / Precordial Exam - Auscultation

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Heart / Precordial Exam - Auscultation

Physiologic Splitting of The Heart Sound

http://med.ucla.edu/wilkes/Physiology.htm
Heart / Precordial Exam - Auscultation

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Heart / Precordial Exam - Auscultation

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Heart / Precordial Exam - Auscultation

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Heart / Precordial Exam - Auscultation

Further Reading:
Lilly Pathophysiology of Heart Disease
Bates Physical Examination

http://med.ucla.edu/wilkes/inex.htm
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The Cardiovascular System

Peripheral
Vascular
Exam
Peripheral Vascular Exam Circulatory System

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Peripheral Vascular Exam Inspection

Xanthelasma
LOOK FOR !
Skin color
Skin lesions
Ulcers
Embolism (black toes, splinter
hemorrhage)
Petechiae or purpura
Xanthoma/xanthelasma
Edema
Varicosities
Clubing Finger
Jugular Venous Pressure (JVP)
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Peripheral Vascular Exam Inspection

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Peripheral Vascular Exam Inspection

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Peripheral Vascular Exam Inspection

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Peripheral Vascular Exam Inspection

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Peripheral Vascular Exam Palpation

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Peripheral Vascular Exam Palpation

HOW TO DISTINGUSH?
JUGULAR VS CAROTID

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Peripheral Vascular Exam Palpation

Carotid

Any Thrill?
Any Bruit?
auscultation
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Peripheral Vascular Exam Palpation

Brachial

Radial

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Peripheral Vascular Exam Palpation

Femoral

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Peripheral Vascular Exam Palpation

POPLITEAL

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Peripheral Vascular Exam Palpation

Dorsalis Pedis

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Peripheral Vascular Exam Palpation

Edema (pitting)

GRADE ?
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Peripheral Vascular Exam Auscultation

Edema (pitting)

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END

Thank You ...