It is a study based on the signs and symptoms of diseases of the cardiovascular system.
Although technology has a high profile in cardiology, the 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 fairly 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 an 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 an accurate 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 spouse, and review of medical records may be required.
Open questions should be asked and time should be allowed to hear the full answer. 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 the presence, severity, and prognosis of cardiovascular disease has been more rigorously established for coronary artery disease, heart failure, and heart disease. valvular heart.
Many clues about the heart condition can be detected with a simple visual inspection. In the acute patient, cyanosis, paleness, and sweating may be signs of imminent danger.
In non-acute patients, cachexia is perhaps the most important feature to consider on general inspection, as it is an important prognostic sign in 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 peripheral vascular disease is an important predictor of coronary artery disease:
- Femoral: sensation at the midinguinal 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.
Before auscultation, inspection of the precordium may be a useful indicator of previous surgery; for example, midline sternotomy suggests a previous bypass, lateral thoracotomy suggests a previous mitral valve or minimally invasive bypass surgery (left internal mammary artery to left anterior descending coronary artery).
The vertex beat should be located: the point furthest laterally and inferiorly where you can clearly 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, eg, aortic stenosis) from thrust (high preload, eg, 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).
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 aortic valve.
- Pulmonary: in 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 possible cardiac disease.