Cardiovascular examination

[ManUtdForever]

---

Members don't see this ad.

Can anyone tell me the correct orders of cardiovascular examination?

I just learnt last week about how to do a complete cardiovascular examination.
However, i watched videos in youtube and it made me confuse. Basically, the steps i was taught were as followed
1) General inspection : eyes, mouth, fingers and pulsation in the precordium area. Some videos i watched actuallly started with fingers and palpation of radial artery, carotid artery and JVP before proceeding to eyes and mouth. So if i do the inspection first before doing all the palpations, does that consider correct
2) Palpation: starts with radial pulse, finding for collapsing pulse, brachial pulse, cartoid pulse and finally JVP. After that, palpate for apex beat, heaves on RV and any thrills on left and right 2nd intercostal space. Ok, this is one if my questions, my teacher also taught me to do pulsation in epigastric region right after pulsation of heaves in GV and also pulsation of thoracic aorta. But i didnt see any videos describing that. Should i perform on my patient?
3) Auscultation: Auscultate the all 4 points and look for murmur

Is there any specific order on which step u do first before proceeding to the next? For example, can i do the inspection of eyes, mouth before proceeding to fingers? Sorry for the long thread...

 

[SurfingDoctor]

The right order is whatever order you need to perform it in to remember all that you need to cover. Or whatever order you need to perform it so you don't miss cardiomyopathy (ie, I didn't see you looking for hepatomegaly or testing for pedel edema, though you get most of it with inspection)

Ok, this is one if my questions, my teacher also taught me to do pulsation in epigastric region right after pulsation of heaves in GV and also pulsation of thoracic aorta. But i didnt see any videos describing that. Should i perform on my patient?

Sure, if you need to test for abdominal aneursyms. Typically with physicals, you don't get marked down for being too thorough.

 

[Dapado33]

ManUtdForever

 

[thoffen]

There's no precise answer because your exam can always be more or less thorough. Some of these things could be considered not part of a cardiac examination but rather a vascular examination, extremities, vitals, HEENT, wherever. In general, though:

1. Inspect first (precordium, jugular veins)
2. Palpate (2 hands on the chest wall, then locate PMI)
3. Percuss (n/a for cardiac exam)
4. Auscultate (all 4 areas in any order with diaphragm and bell, left lateral decubitus)

Some may include a (limited) vascular exam particularly carotid auscultation and distal pulses. You may also want to check for hepatojugular reflux and pedal edema. I usually record these under sections for neck and extremities when doing my notes. None is more correct than the other.

The exception to the rule inspect -> palpate -> percuss -> auscultate is the abdominal exam where you ascultate after inspecting.