PEMERIKSAAN FISIK KARDIOVASKULER GENERAL INSPECTION ( LYING 45 )

Dyspnoe

Cyanosis

Down Syndrome

Rheumatologycal Disorders, e.g. ankylosing Spondylitis ( aortic regurgitation )

Acromegaly etc,..

FINGER CLUBBING

HANDS

Radial Pulses right and left

Radiofemoral delay

Clubbing

Signs of infective endocarditis

Peripheral cyanosis

Xanthomata

Face

Eyes

Sclereae pallor ( anemiae ), jaundice

Xanthelasma

Malar flush ( mitral stenosis, pulmonary stenosis )

Mouth

Cyanosis

Palate ( high arched marfans )

Dentitition ( risk of endocarditis ) NECK

Jugular venous pressure Central venous pressure hight

Wave form ( especially large v wave )

Abdominojugular reflux test

Carotids pulse character

PRAECORDIUM

Inspect

Scars whole chest, back

Deformity

Apex beat potition, character

Abnormal pulsations

PALPATE

Apex beat potition, character

Thrill

Abnormal impulses AUSCULTATE

Heart sounds

Murmurs

Potitions patient

Left lateral position

Sitting forward ( forced respiratory apnoea )

NB : palpate for thrills again after potitioning.

DYANAMIC AUSCULTATIONS

Respiratory phases

Valsalva

Excercise ( isometrics, e.g. hand drip )

Standing

Squating

BACK ( SITTING FORWARD )

Scars, deformity

Sacral Oedema

Pleural effusion ( percuss )

Left ventricular failure ( auscultate )

ABDOMEN ( LYING FLAT 1 PILLOW ONLY )

Palpate liver ( pulsatile etc ), spleen, aorta

Percuss for asites ( right heart failure ) Femoral arteries palpate, auscultate

LEGS Peripheral pulses

Cyanosis, cold limbs, tropic changes, ulceration ( peripheral vascular disease )

Oedema

Xanthomata

Calf tenderness

Clabbing of toes

=Selamat Bekerja=