SpecIfic CVS examination

Inspection(undreess patient to the waist,inspect carefully for 10 scnd),lying 45 degree

Comment on:

1. Chest wall movement with each respiration
2. symmetrically or not
3. chest wall deformity
4. surgical scar
5. silated veins
6. skin discolouration
7. visible pulsation
8. Pecardial bulge
   

Palpation

1. Apex beat( mitral area)
2. Cari apex beat from inferior lateral region,dy biasa beloow nipple skit
3. If x jumpa,roll pateint over left side
4. LOcate apex beat (tunjuk kat examiner kiraan ribs)
5. Access character of :Tapping, Heaving(forceful,sustained,undisplaced impulse "pressure overload due to aortic stenosis/ LV hypertrophy),Thrusting (forceful,unsustainedd,undislace impulse->aortic regurgitation/enlargmnt in mitral),Thrill( palpable murmur)
6. Palpate using palm for: parasternal heave(fro rt ventricular & left atrial hypertrophy),thrill at mitral ,aortic and pulmonary area.suggestd for any stenosis

Auscultation

1. Mitral area->using bell,listen for pan systolic murmurs suggested mitral stenosis
2. using diapghrm->trace up from mitral area to axillae suggested mitral regurgitation
3. Tricuspid area-> serach for pansystolic murmurs( ask patient to breath in ,hold and breath out)
4. Pulmonary area nad aortic area->listen for ejection systolic murmurs for aortic and pulmonary stenosis
   
5. listen kt lt n rt carotid area sugested for ejaction systolic murmur radiate to carotid area,
6. sit the pateint up and listen at 3 area again. This time ask patient to breath in,breath out and hold.

1. Impapable apex beat due tu:
   

• obesity
• pleural & pericardial effusion
• COPD
• Dextocardia(rasa kr sbelah kanan)