Cardiac Exam

1
Cardiac Exam

• The cardiac exam includes
• Inspection of jugular venous pressure
• Inspection, palpation, and auscultation of the 4
  cardiac areas with the diaphragm
• Auscultation over the tricuspid and mitral areas
  with the bell
• Special maneuvers

2
103-104 Inspection Jugular Vein Inspection of
jugular venous pressure should be done with the
patient lying with their head tilted to the left
side. The patient should be elevated to the
point where jugular venous distention is seen in
the mid-neck. In a patient with a markedly
elevated jugular venous distention, they may
actually need to be sitting upright , or in a
patient with a low-normal jugular venous pressure
this may need to be at 0o to see the distention
in the mid-neck. Remember that the rest of the
cardiac exam should be done with the pt at 30o
3
106-110 Inspection and Palpation
106-110 Inspection and Palpation

• Inspection done correctly right side, head
  tilted left, patient elevated. (Note in a female
  patient they may have the gown on like in the
  picture during inspection)
• Inspection, palpation and auscultation for rest
  of cardiac examination performed at 30 degrees
• Inspection of all 4 areas
• Palpation of aortic area (right second
  intercostal space just lateral to sternum)

4
Palpation of pulmonic area
Left second intercostal space just lateral to
sternum
5
Palpation of right ventricular and tricuspid area
Left lower sternal border
6
Palpation of apical area

• If apical impulse not palpable, patient in left
  lateral decubitus
• Palpation done with fingerpads in all 4 areas
• Palpation of apical area (about fifth intercostal
  space mid-clavicular line)

7

• Palpation Apical Area
• If apical impulse not palpable, patient in left
  lateral decubitus

8
113-122 Cardiac Auscultation

• Auscultation with Diaphragm Aortic area
• Auscultation with Diaphragm Pulmonic area
• Auscultation with Diaphragm Tricuspid area (left
  lower sternal border)
• Auscultation with Diaphragm Mitral area (apical
  area)
• Auscultation with Diaphragm Sitting, left lower
  sternal border, patient fully exhaled

9
Cardiac Auscultation

• Auscultation with bell. Mitral area
• Auscultation with bell. Mitral area in the left
  lateral decubitus position
• Done correctly - Bell applied light pressure, not
  heavy (remember newer stethoscopes diaphragm
  lightly OK)
• Auscultation with bell. Tricuspid area

10
117 Auscultate with the diaphragm at the left
lower sternal border with the patient sitting and
fully exhaled. This is the optimal position to
listen for aortic insufficiency. (Note this is
a different patient!)