Cardiac Physical Examination

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CARDIO-VASCULAR:
A) Inspection:
1. Scars : valve lesion, surgery
- pacemaker box-under pec. muscle
2. Skeletal abnormalities : pectus escavatum(funnel chest)
- Kyphoscoliosis - Marfan’s syndrome-move position of heart-move apex beat 3. Deformities: interfere pulmonary function – pulmonary hypertension 4. Apex beat : Normal position – 5th left intercostal space, 1cm medial midclavicular line B) Palpitation:

1. Apex beat: - palpable apex beat above anatomical apex
- palpable in 40% normal individuals - Character – normal – lift palpating finger Abnormal apex beats:
i)Pressure loaded - forceful sustained impulse
Systolic overload: aortic stenosis, hypertension
ii)Volume loaded – Thrusting
Displaced, non sustained: mitrial regurgitation, dilated cardiomyopathy

iii)Dyskinetic - Uncoordinated
LV dysfunction e.g MI

iv)Double/tapping - 2 impulses
Hypertrophic cardiomyopahty
2. Parasternal impulses:
If palpable: RV or LA enlargement
Pulmonary hypertension
3. Thrills/murmers:
Thrills – palpable murmers – turbulent bloodflow
Systolic thrill: coincide with apex beat
Diastolic thrill: not coincide with apex beat
C) Percussion: 5th intercostal space
D) Auscultation: (most NB in cardio examination)
1. Normal heart sounds:
S1: beginning ventricular systole – mitrial & tricuspid valve closure S2: end of systole – softer, shorter, higher pitch
- aortic & pulmonary valve closure (5th intercostal space) 2. Splitting: - closure of pulmonary valves later than aortic valves - 70% adults – splitting of 2nd heart sound - wider on inspiration, S2 beginning systole...
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