Index
It is a study based on the signs and symptoms of diseases in the cardiovascular system.
Although technology has a high profile in cardiology, clinical examination remains a central tool, especially for the general practitioner.
The explanation of common pathologies reveals that cardiovascular symptoms can be very far from being specific; they are often absent or do not manifest themselves for a long time, even sometimes it is necessary to be rigorous, relying on objective findings such as risk factors, an interview detailed and a complete clinical examination.
Risk factor assessment provides an initial and reasonably accurate picture of the quality of a patient’s vascular system and, at the same time, the advisable level of surveillance.
The interview, adapted to cardiovascular symptoms, provides more details about the possible existence of underlying pathology.
A cardiovascular history is obtained to identify evidence of organic heart disease or symptoms that suggest the presence or possible presence of cardiovascular abnormalities.
Taking a real story is an acquired skill that is honed through experience.
The details of the history may vary depending on the physical and emotional state of the patient, his educational, cultural, and economic background, and the way the questions are asked.
Direct questions, questions of family members and spouses, and a review of medical records may be required.
Open questions should be asked, and the complete answer should allow time to hear. Top questions should be avoided.
Finally, the clinical examination may reveal an established disease or one that is still in the early stages, leading to referral to a specialist.
The evidence base linking medical history and physical examination findings to cardiovascular disease’s presence, severity, and prognosis have been more rigorously established for coronary artery disease, heart failure, and heart disease. Valvular heart.
Inspection
A simple visual inspection can detect many clues about the heart condition. Cyanosis, paleness, and sweating may be signs of imminent danger in the acute patient.
In non-acute patients, cachexia is perhaps the essential feature to consider on general inspection, as it is a crucial prognostic sign of heart failure.
Taking a pulse is one of the simplest clinical tests. The rate should be recorded and the pulse rhythm documented.
The character and volume of the pulse can also be helpful signs, and these are traditionally thought to be easier to detect in larger arteries such as the brachialis and carotid arteries.
Peripheral pulses should also be documented, as the peripheral vascular disease is a significant predictor of coronary artery disease:
- Femoral: sensation at the mid inguinal point (midway between the symphysis pubis and the anterior superior iliac spine, just below the inguinal ligament).
- Popliteus – Sit deep in the center of the popliteal fossa with the patient lying on his back with the knees bent.
- Posterior tibial: feel behind the medial malleolus.
- Dorsalis pedis: sensation on the second metatarsal bone lateral to the extensor hallucis tendon.
Palpation
Before auscultation, an inspection of the precordium may be a helpful indicator of previous surgery; for example, midline sternotomy suggests a previous bypass, lateral thoracotomy offers a last mitral valve, or minimally invasive bypass surgery (left internal mammary artery to left anterior descending coronary artery).
The vertex beat should be located: at the point furthest laterally and inferiorly where you can feel the vertex (usually the fifth intercostal space in the midclavicular line).
There are many different descriptions for abnormal apex beats. One scheme distinguishes overload (high posterior loading, e.g., aortic stenosis) from thrust (high preload, e.g., aortic regurgitation).
In addition, the left hand should be placed on the sternum and palpated for significant ventricular lift (right ventricular hypertrophy) or emotion (tight aortic stenosis, ventricular septal defect).
Auscultation
Considered by many to be the key to physical examination, the importance of auscultation remains but diminishes in an era of echocardiography.
In a systematic evaluation, auscultation is performed in the following foci:
- Aortic: in the aortic valve.
- Pulmonary: in the pulmonary valve.
- Mesocardial: in interventricular septum.
- Mitral: in mitral valve.
- Tricuspid : en tricuspid valve.
In today’s high-tech age, there is still no technique in medicine to improve the effectiveness of a thorough and systematic physical examination.
The physical examination provides vital information for the diagnosis and management of the possible cardiac disease.
