Alright, so now we're going to jump in to our discussion of the cardiovascular exam.
I should preface right off the bat, that this is not intended
to be a comprehensive course on the assessment of the heart.
A person could spend hours, days, weeks,
going over all the different kinds of manifestations of cardiovascular disease,
the different kinds of murmurs that can appear,
the different maneuvers you can do to elicit or suppress certain murmurs and cardiac findings,
not to mention the entire wealth of findings
there may be in pediatric or congenital cardiac malformations
which I am not going into in this course.
Instead my intention is to make sure that we have a good foundation on the common murmurs
that you're going to find at the bedside and a list of a few of the common maneuvers
that you can do to really accentuate those murmurs.
But first off, the cardiac exam always starts when you walk in the room,
long before you start putting this on your patient,
and essentially when I look at your patient and decide whether or not they really are in distress.
You know a patient is complaining of chest pain could just be from some sort of musculoskeletal injury
and they could be quite comfortable sitting there
and not have any other evidence of any systemic or cardiovascular badness happening at that time.
In contrast, a person who's in acute coronary syndrome,
it shouldn't be that subtle if they have a significant coronary event happening.
They may have diaphoresis on their forehead with evidence of just sweating.
They may look really anxious and uncomfortable.
And certainly they may be in a respiratory distress
which we'll talk a little bit more about in the pulmonary section
and, hey, they may even be clutching their chest right before your eyes as evidence
of the source of this crushing chest pain that they're experiencing.
So, having done that, our patient at least at the moment looks fairly calm,
doesn't look like he's having a lot of anxiety, he's not clutching his chest
and he's not diaphoretic, such a good sign, we can take our time by examining this patient.