1. Cardiovascular System Hossam Hassan

2. Examination of The Cardiovascular system  Introduce yourself : I am Dr/Mr/Ms…….. May I examine Your Heart?  Ensure adequate exposure of the precordium : “would you take your top off, please? However, be sensitive of the feeling of female patients.  Get patient to sit at 45 degree – use pillows to support the neck.  Inspection : comment on the patients decubitus (whether he or she is comfortable at rest or obviously short of breath);comment on malar flush (seen in mitral stenosis.

3.  Examine the pulse : rate (count for 15 s),rhythm,character,volume; lift the arm to feel for the collapsingpulse.feel the other radial pulse simultaneously.  Comment on the scar at antecubital fossa (cardiac catheterization scars.).  Look at the tongue for pallor,central cyanosis.  Look at the eye for pallor,argyII Robertson pupil.

4.  Examine the Jugular venous pulse :comment on the wave from and height from the sternal angle, Check the abdominojugular reflux.  Comment on any carotid pulsation (Corrigan's sign of aortic regurgitation).  Examine the precordium : comment on surgical scars (midline sternotomy scars, thoracotomy scars for mitral valvotomy may be missed under the female breast).  Fell the apex beat –position and character.  Feel for left parasternal heave and thrills at the apex and either side of the sternum.

5.  Listen to the heart,beginning from the apex: take care to palpate the right carotid pulse simultaneously so that the examiner notices that you are timing the various cardiac events. Always comment on the first and second heart sounds. Mention any additional heart sounds. If you do not hear the mid diastolic murmur of mitral stenosis make sure you listen to the apex in the left lateral position with the bell of the stethoscope.If you hear a murmur at the apex, ensure that you get the patient to breathe in and out- the examiner will be observing whether or not you are listening for the variation in intensity with respiration if you hear a pan systolic murmur, listen at the axilla(mitral regurgitate murmur are conducted to the axilla).

6.  Using the diaphragm of your stethoscope listen at the apex,below the sternum, among the left sternal edge,the second right intercostal space and the neck (for ejection systolic murmur of aortic stenosis aortic sclerosis).  Request the patient to sit forward and listen with the diaphragm along the left sternal edge in the 3 rd intercostal area with patients breath held in expiration for early diastolic murmur of aortic regurgitation.  Tell the Examiner that you would like to do the Following :  Listen to lung bases for signs of cardiac failure  Check for sacral leg edema  Examine the liver (tender liver of cardiac failure),splenomegaly(endocarditis).  Check the blood pressure.  Check the peripheral pulses and also check for radio femoral delay.

7. THANK YOU DR. Hossam Abdalraziq