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Quick Review: Examination of the Cardiovascular System

by Stephen Holt, MD, MS

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    00:01 Alright, so now let's review some of the material that we've covered.

    00:04 In this table, we're going to review just a few key points in each column starting with acute coronary syndrome.

    00:10 The most important feature and the physical exam for acute coronary syndrome is does the patient look distressed? Is there evidence of diaphoresis? anxiety? Is the patient clutching their chest and certainly are they dyspneic? When you're thinking about patients with heart failure, your going to be looking for labored breathing, you're looking for that third heart sound.

    00:27 And then we're using those other ancillary findings like increased jugular vein distension, whether it's the external or internal jugular vein, peripheral edema and the presence of crackles, particularly so called wet or coarse crackles, Pericarditis, you expect the patient may be leaning forward to take some of the tension off of the pericardial sac.

    00:47 And you're going to be listening for that friction rub right over the apex of the heart.

    00:52 And then of course, if you think that person has pericarditis you also want to evaluate for cardiac tamponade, which can be an emergency.

    00:59 So you're going to be using your skills at pulsus paradoxus, to determine whether or not there is an increased gap between inspiration and respiration.

    01:08 Alright, so let's take a look at this question.

    01:10 Which murmur is accentuated by the valsalva maneuver? Well, mitral regurgitation, if we use the valsalva maneuver, we're going to be decreasing venous return less blood means a quieter murmur of mitral regurge.

    01:26 So that's not the right answer.

    01:27 The murmur of hypertrophic cardiomyopathy, that is definitely going to be our right answer.

    01:32 As we talked about when the left ventricular walls come closer together.

    01:36 That sound that's caused by turbulent flow past the subaortic valve stenosis is going to become louder.

    01:44 Aortic stenosis should become decreased in loudness, as would tricuspid regurgitation.

    01:49 Which factors would not help when listening for an S4 gallop? Have the patient Valsalva, use the bell, left lateral decubitus position, or listening at the apex.

    02:05 The best way to listen for a fourth heart sound or a third heart sound is using the belt because it's going to detect lower pitches.

    02:12 The left lateral decubitus position will help to bring the heart closer to the chest and you want to listen at the apex because that's where you're best going to hear the sound of blood hitting against the stiff left ventricular wall during the left atrial kick.

    02:29 So the answer is having the patient Valsalva would not help.


    About the Lecture

    The lecture Quick Review: Examination of the Cardiovascular System by Stephen Holt, MD, MS is from the course Examination of Cardiovascular and Respiratory System.


    Author of lecture Quick Review: Examination of the Cardiovascular System

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS


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