Clinical examination:
- We usually begin by measuring vital signs: awareness, general Situation, orientation of time and place, and checking pulse (in the four limbs, Checking pulse over the carotid artery)
- Number
of breathing times and O2-saturation.
- Temperature measurement.
- Measuring arterial pressure.
The
cardiovascular examination includes three components: inspection, palpation and
auscultation.
General inspection:
- Should be done from head to foot, here should pay attention to the special Facies, which appear in some syndromes.
Examples:
Syndrome | Cardiac defect |
hereditary telangiectasia syndrome | pulmonary arteriovenous fistula |
LEOPARD syndrome (abnormalities of the skin, heart, inner ears, and genitalia) | pulmonal stenosis |
Paget's disease | arteriovenous shunt |
Nail clubbing | Cyanotic heart defect / Endocarditis |
Down Syndrome | Endocardial Cushion Defect (VSD + ASD) and Tetralogy of Fallot |
Noonan's syndrome | Supravalvular or subvalvular pulmonary stenosis |
Williams syndrome | supravalvular aortic stenosis |
Turner syndrome | Aortic Isthmus stenosis |
Behçet's disease | uveitis |
- Symmetry: congenital pulmonary arteriovenous fistula may be associated with asymmetry of the face.
- The edema (face, neck, collateral circulation in the upper section of the chest wall) may refer to Superior vena cava syndrome
- Neck symmetry
- lymphadenopathy
- collateral circulation in the upper section of the chest wall
- heart auscultation points, especially Cardiac Apex Beat
- Chest symmetry and form: (The left part of the chest is convex: often Congenital Heart Defects, called Cushion Defect)
- Lateral circulation in the lower chest and upper abdomen
- abdominal inspection, limbs, then spine (kyphosis, scoliosis, straight back associated with mitral valve prolapse)
First: Ventricular diastole phase:) Duration of 0.5 seconds)
Ventricular
diastole passes through five phases:
- Isovolumic relaxation phase: (all valves) are closed.
- Rapid-filling inflow phase (passive): where the mitral valve opens and 80% of the blood flows from the atrium to the ventricle.
- Slow-filling phase: where 5% of the blood flows from the atrium to the ventricle.
- Balance in pressure and non-flow phase: where the pressure between the atria and the ventricle is equal and blood does not flow.
- Atrial systole phase (Active): 15% of the blood flows from the atrium to the ventricle
Second:
ventricular systole phase: (Duration
of 0.3 seconds)
- Atrial
contraction increases the pressure in the ventricle thus mitral valve closes
(the first sound), and the aortic valve here has been closed since the
beginning of diastole, here the ventricle becomes a closed chamber (Isovolumic
contraction)
- In the next phase,
the pressure in the left ventricle increases at a speed of "120 mmHg"
until it becomes greater than the pressure within the aorta. "80 mmHg The
aortic valve opens and the ventricular systole phase begins and the blood flows
from the left ventricle to the aorta.
- The ventricular pressure gradually decreases, When the pressure in the aorta becomes higher than the pressure in the left ventricle, the aortic valve closes (the second sound S2). At this time the mitral valve is still closed and the ventricle becomes a closed chamber again. This isovolumic relaxation phase
- With ventricular diastole, the pressure in the ventricle decreases until it is lower than the pressure in the left atrium (which is full) and the mitral valve opens, and so on.
The contraction period is a fixed period, and the relaxation period is longer, so in case of tachycardia it occurs at the expense of the relaxation period.In relaxation period occurs ventricular filling and coronary perfusion.
The left side corneal perfusion is done with relaxation, and the right side in contraction and relaxation.
Atrial contraction passes 15% of the blood naturally, but in the case of heart failure the rate reaches 40% which is very important, as in the absence (for example, in the case of atrial fibrillation) worsens the situation of the patient.
The third cardiac sound occurs due to the rapid filling of the ventricle followed by a sudden stop (it can be heard in the case of the diastolic heart failure, for example).
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