Cardiovascular Exam

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Preparation

  • Position and gown patient
  • ALWAYS stand to patient's right side

Inspection

  • Inspect ankles for signs of edema
  • Identify carotid and jugular pulse

Pulse and Blood Pressure

  • Note vital sign values
  • Measure pulse and blood pressure if no values are reported or if values are abnormal

Special Consideration: Irregular Pulse

  • Measure up to a minute

Carotid Pulsations

  • Observe pulsations in neck
  • Palpate one side at a time
  • Note amplitude and contour

Special Consideration: Auscultation for Bruits

  • Place diaphragm or bell over each carotid artery
  • Ask patient to hold their breath momentarily

The Precordium

  • Observe for precordial movement
  • Identify apical pulse visually
  • Palpate apical pulse/PMI
  • Palpate for extra movement

Auscultation with the Diaphragm

  • Auscultate aortic area (R 2nd IS)
  • Auscultate pulmonic area (L 2nd IS)
  • Auscultate tricuspid (L sternal border)
  • Auscultate mitral area (PMI)

Auscultation with the Bell

  • Auscultate mitral area (PMI)
  • Auscultate other areas as time permits

Special Consideration: Jugular Venous Pressure

  • Position on exam table starting with head elevated 30 degrees
  • Use tangential lighting
  • Identify jugular venous pulse (distinct from carotid pulse)
  • Adjust bed angle as needed
  • Measure distance of pulse above sternal angle

Special Consideration: S3 and Mitral Murmurs

  • Roll patient on left side
  • Palpate to locate PMI
  • Auscultate in the mitral area (PMI) with the bell

Special Consideration: Aortic Insufficiency

  • Position patient sitting and leaning forward
  • Ask patient to exhale
  • Auscultate the L 3rd and 4th IS with the diaphragm

The heart sounds in this video were used with permission from Synapse Publishing, Inc. You may hear these and other cardiac sounds at http://www.medlib.com/spi/coolstuff2.htm.

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