A difference in the timing of pulses between the two radial arteries can indicate conditions such as aortic coarctation or subclavian stenosis.
Radio-femoral delay is a hallmark of coarctation of the aorta, where the pulse at the femoral artery is delayed compared to the radial pulse.
Narrowing or blockage of peripheral arteries, leading to reduced blood flow to the extremities.
A collapsing (water hammer) pulse is often associated with aortic regurgitation, where blood flows back into the left ventricle during diastole.
Proteinuria, hematuria, or signs of infection.
The pulmonary valve is auscultated at the left 2nd intercostal space.
The aortic valve is best heard at the right 2nd intercostal space.
Turning the patient to the left lateral position brings the apex of the heart closer to the chest wall.
Vital signs provide key information on the cardiovascular and respiratory system's status.
Right heart failure or tricuspid regurgitation.
Displacement, such as to the left, suggests ventricular enlargement, like left ventricular hypertrophy.
A murmur here may indicate pulmonary stenosis or regurgitation.
Listening for bruits can suggest carotid artery stenosis, a risk factor for stroke.
Corneal arcus suggests hyperlipidemia, and xanthelasma indicates cholesterol deposits on the eyelids, both being risk factors for atherosclerosis.
Signs of hypertensive or diabetic retinopathy.
It damages them, leading to hemorrhages, exudates, and papilledema.
Pulmonary stenosis causes obstructed blood flow from the right ventricle into the pulmonary artery.
Increased pressure in the pulmonary circulation leads to fluid leakage into the alveoli.
Pallor suggests anemia, cyanosis suggests hypoxia, and a high-arched palate can be associated with congenital heart disease.
Aortic stenosis or regurgitation murmurs can be heard here.
The tricuspid valve is best auscultated at the left 4th intercostal space, along the lower left sternal edge.
Aortic regurgitation results in backflow of blood into the left ventricle during diastole.
Parasternal heaves indicate right ventricular hypertrophy.
In aortic stenosis, blood is ejected through a narrowed valve during systole, creating a high-pitched ejection systolic murmur.
Leaning forward brings the aorta closer to the chest wall, enhancing murmur detection.
Pallor may indicate anemia, while scleral icterus suggests jaundice, often secondary to liver dysfunction or hemolysis.
Peripheral arterial disease (PAD), a marker of systemic atherosclerosis.
JVP reflects right atrial pressure and is elevated in conditions like heart failure, tricuspid regurgitation, or pulmonary hypertension.
The diaphragm is used for high-pitched sounds like mitral regurgitation.
Poor perfusion or respiratory compromise.
Chronic venous congestion.
It ensures cooperation and trust, aligning with ethical clinical practice.
The mitral area is located at the 5th intercostal space, midclavicular line.
Atherosclerotic plaque narrows the carotid artery, causing turbulent blood flow.
It leads to kidney damage and proteinuria.
The apex beat is normally located at the 5th intercostal space at the midclavicular line.
Thrills indicate turbulent blood flow, typically due to valvular stenosis or regurgitation.
One side is palpated at a time to avoid stimulating the carotid sinus, which can cause a reflex bradycardia.
Mitral stenosis results from narrowing of the mitral valve, causing turbulent flow during diastole, leading to a low-pitched murmur.
Increased venous pressure in heart failure causes fluid to leak into the interstitial tissues, resulting in edema.
To prevent the spread of infection after physical contact with the patient.
A palpable P2 suggests pulmonary hypertension.
Full expiration accentuates left-sided heart murmurs like aortic regurgitation.
Pedal edema is a sign of fluid retention, often seen in heart failure.
It assesses volume and character, such as slow-rising in aortic stenosis or bounding in aortic regurgitation.
In tricuspid regurgitation, blood flows back into the right atrium during systole, creating a pansystolic murmur.
Listening to the lung bases helps detect signs of heart failure, such as crackles.
Abnormal chest pulsations may be caused by ventricular enlargement or turbulent blood flow due to valvular defects.
Signs include clubbing (suggesting chronic hypoxia), pallor (indicating anemia), cyanosis (seen in poor oxygenation), and stigmata of endocarditis, such as splinter hemorrhages or Osler’s nodes.
Endocarditis causes immune complex deposition and microemboli formation, leading to characteristic lesions on the hands.
Adequate exposure allows for a clear view of the chest for inspection and palpation, ensuring proper assessment of the skin, muscles, and any abnormalities.
It establishes rapport, gains patient consent, and ensures the patient understands the procedure, creating a comfortable environment.
The chest wall should be inspected for scars, deformities, or abnormal pulsations, which may indicate previous surgeries, affect heart or lung function, or suggest conditions like right ventricular hypertrophy.
This position optimizes venous return to the heart and is ideal for assessing jugular venous pressure (JVP), providing a clear view of pulsations or abnormalities on the chest wall.
Hand hygiene is essential to prevent infection transmission between patient and examiner, ensuring cleanliness and reducing the risk of healthcare-associated infections.
Palpating the radial pulse assesses heart rate, rhythm (regular or irregular), and character (bounding, weak), with irregular pulses potentially indicating arrhythmias like atrial fibrillation.
