Examination of the Heart.ppt

Examination of the Heart
In the present era of technological advances, particularly in the various imaging modalities, there is a growing conception among practicing physicians in cardiovascular medicine that bedside physical examination is unnecessary and does not provide useful information.
Examination of the Heart
It should be emphasized, however, that for proper application and interpretation of various new and old tests that are available for cardiovascular evaluation in a given patient. Bedside clinical examination should be performed and practiced in the same way following similar sequences.
Examination of the Heart
Preparing the patient
The heart examination should be made as easy as possible for the patient.
The ideal examining room is private, warm enough to avoid chilling, and free from distracting noise and sources of interruption. Adequate (preferably fluorescent or natural) light is essential.
Examination of the Heart
Landmarks and topographic
anatomy
Certain basic landmarks

midsternal line
midclavicular lines
Certain basic landmarks
anterior, middle, and posterior
axillary lines
suprasternal notch
identification of various ribs and
intercostal space
Specific areas for cardiac PE
sternoclavicular area
aortic area
pulmonary area
Specific areas for cardiac PE
anterior precordium
apical area
epigastric area
ectopic area
Inspection
Observe precordium
Precordial bulge
congenital heart disease(before puberty)
pericardical effusion (adult life)
Inspection
Pulsation
apical impulse
The apical impulse is occurring early in systole. In adults the apical impulse normally is located in the left fifth intercostal space, either at or medial to the mvl and about 2- cm diameter, it serves the examiner as a marker for the onset of cardiac contraction.
Normal apical impulse:
It’s location
duration
intensity
amplitude