Cardiological

Examination
I Gede Bungas Arisudana
1061050067

Jugular venous
pressure(JVP).

Position of the patient at (30), head.

Use tangential lighting and examine both sides of
the neck. Identify the external jugular vein on
each side, then find the internal jugular venous
pulsations.

Jugular venous
pressure(JVP).
Venous pressure

measured at >3 cm, or

possibly 4 cm, above
the sternal angle, or
more than 8 cm or 9 cm
in total distance above
the right atrium, is
considered elevated
above normal.

Heart examination;
Inspection :
1.

Point of maximal impulse

Heart examination
Palpation :
1.
2.

Apex beat 5th ICS midclavicular line.

Thrill (vibrating sensation indicates palpable
murmur).

Heart examination;
Appex
1.Location
2.Diameter
3.Amplitude
4.Duration

Location
Locate two points:
the interspaces, usually the 5th or possibly the 4th,
which give the vertical location and the distance in
centimeters from the midclavicular line

Diameter
Palpate the diameter of the apical impulse. In the
supine patient, it usually measures less than 2.5
cm

Amplitude
Estimate the amplitude of the impulse. It is
usually small and feels brisk and tapping,
Some young adults have an increased amplitude
or hyperkinetic impulse, especially when excited
or after exercise; its duration, however, is normal.

Duration
To assess duration, listen to the heart sounds
as you feel the apical impulse, or watch the
movementof your stethoscope as you listen at the
apex. Estimate the proportion of systole occupied
by the apical impulse

Heart Examination
Percussion
It is outlined by percussing in the 5th, 4th, 3rd
and 2nd interspace on the left sequentially,
starting near the axilla and moving medially until
cardiac dullness is encountered.

Heart examination

Auscultation:
1. bell to detect low-pitched
sounds ,
press lightly
against the skin
2. diaphragm detect highpitched sounds
press firmly against the skin

Heart Examination

Normally audible heart sounds:

1st & 2nd HS
Added sounds: 3rd & 4th HS, pericardial friction
rub (pericarditis), opening snap (m.s)
murmurs

Murmurs
Turbulent blood flow caused by diseased valve or
if a large amount of blood flows through a normal
valve.
characteristics of murmurs suggest the cause of
it (site, radiation, pitch, timing and the intensity) .

Murmurs
Systolic; time between 1st and the 2nd
HS, could be mid-systolic (AS),
pansystolic (MR).
Diastolic; time between 2nd and the 1st
HS, can be divided into three phases.
Early (AR), Mid-diastole (MS),
Presystole.

Murmurs

Gradations of murmur
Grade

Description

Grade 1

Very faint, heard only after

examiner has tuned in, may
not be heard in all position

Grade 2

Quiet, but heard immediately

after placing the stethoscope
on the chest

Grade 3

Moderately loud

Grade 4

Loud, with palpable thrill

Grade 5

Very loud, with thrill. May be

heard when the stethoscope is
partly off the chest

Grade 6

Very loud, with thrill. May be

heard with stethoscope entirely
off the chest