the cardiovascular system

The cardiovascular system

Jugular venous pressure and pulse (JVP).
- elevated the bed about 30º.
• Inspection-palpation:
- Jugular pulse in the both sides of neck.
• Measured JVP:
- Put ruler on the sternal angle.
- Then place along rectangular horizontally.
- Normal from 3-4 cm.
- Increase JVP  right side heart failure.
The heart
• Heart rate:
- Radial pulse (most using)  rhythm and contour.
- Others place  brachial, carotid, temporal, femoral, popliteal, dorsal pedis and posterior tibial pulse.
• Blood pressure.
Inspection:
• Cyanosis.
• Location of the apical impulse and left-ventricular movement S3, S4 (rarely).
Palpation: 5 places:
1. Right 2nd I.C  aorta pulse.
2. Left 2nd I.C  pulmonary pulse.
3. Left 3rd, 4th, and 5th I.C  ventricular pulse.
4. Left 5th I.C × midclavicular line  apex pulse.
5. Subxiphoid area  epigastric pulse.
Percussion:
• Horizontally on I.C space, from base to apex
• Resonance  dullness  resonance.
Auscultation: 5 places:
• S1 (lob), S2 (dub)  S1-systole- S2-diastol-S1.
• S2 > S1 (in the base of heart).
• S1 > S2 (in the apex area).
• S3 in children.
• Abnormal sounds:
- S3 (in adult), and S4.
- Murmurs sound (narrow of coronary artery) described liming, shape, location, intensity, pitch, and quality.
- Fracture rib.
# Ask the pt to change position, then exam sound.
# Ask him to breathing (complete exhale and stop), then exam sound.