Topic 6 of 74 in the MU Plovdiv syllabus for Internal Diseases (Dental Medicine, Year 3). The free AceMed note covers it in 7 sections, about 631 words (6 min of reading), with 28 flashcards.
In this note
Physical methods of examination of a patients with cardiac disease—inspection, palpation, percussion
A. Inspection
B. Palpation
C. Percussion
Heart auscultation. Heart sounds and murmers
Steps for Auscultation:
Important Auscultation Points:
A. Inspection
1. Precordium:
Bulges: Could indicate aneurysms, enlarged heart, or pericardial effusions.
Visible Apex Beat: Suggests displacement due to heart failure, hypertrophy, or cardiomyopathy.
Scars: Typically from heart surgeries like valve replacement, bypass, or pacemaker insertion.
2. Peripheral Signs:
Cyanosis:
Central Cyanosis: Observed in the lips/tongue, typically due to left-sided heart failure (poor oxygenation).
Peripheral Cyanosis: Seen in fingers/toes, may be linked to right-sided heart failure (poor circulation).
Clubbing: Seen in chronic cyanosis, often seen in congenital heart disease or chronic lung conditions.
Edema:
Leg Edema: Indicates right-sided heart failure or venous insufficiency.
Ascites: Suggests portal hypertension (common in right heart failure).
Jugular Venous Distention (JVD):
Reflects increased central venous pressure.
Common in right-sided heart failure, tricuspid regurgitation, and pericardial tamponade.
B. Palpation
3. Apex Beat:
Location: 5th intercostal space, midclavicular line (MCL).
Character:
Tapping: Normal.
Heaving: Suggests left ventricular hypertrophy (LVH).
Displaced: Can be seen in heart failure or dilated cardiomyopathy (displaced laterally).
4. Thrills:
Feel for vibrations over valve areas:
Aortic Valve: Right 2nd intercostal space, right sternal border.
Pulmonic Valve: Left 2nd intercostal space, left sternal border.
Tricuspid Valve: Left 4th or 5th intercostal space, lower sternal border.
