2. Cardiovascular System

Inspection

Visible chest deformities in the precordium absent humpback

Visible point of maximal impulse present absent

Abnormal apex beat high diffused displaced to the left downward

Abnormal pulsations cardiac beat epigastric jugular fossa in the 2^nd 3^rd 4^th intercostal space to the right to the left of the sternum carotid pulsation "carotid shudder" de Musset’s sign absent

Visible venous pulse positive negative absent

PALPATION

Point of maximal impulse

Apex beat impalpable

Position in the ___ ^th intercostal space, ____ cm from the left midclavicular line toward the sternum laterally

Area ________ cm² normal diffuse concentrated

height normal high low

strength normal forceful weak

Cardiac beat present absent

Thrills systolic diastolic presystolic apex base of heart

Epigastric pulsation present absent

Pulse synchronous non- synchronous identical different on both hands

rate _______ beat per minute infrequent

rhythm regular irregular

volume normal large-volume/full small-volume

equality uniform unequal/non-uniform

tension normal hard/tense soft

swiftness not changed swift/quick/abrupt slow-rising

vessel wall normal

pulse deficit absent present = _______ beat

dicrotic pulse pulsus paradoxus anacrotic pulse filiform pulse

peripheral pulses (normal, reduced, absent, aneurismal: radial, brachial, carotid, femoral, popliteal, posterior tibial, dorsalis pedis)

Sites and description of any abnormality ________________________________

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PERCUSSION

The borders of relative cardiac dullness:

right: in ____ ^th intercostal space, along the right edge of sternum ____ cm laterally

left: in ____ ^th intercostal space, ____ cm from left midclavicular line toward the sternum laterally along left midclavicular line

upper: lower edge of the ______ rib.

The borders of absolute cardiac dullness:

right: in ______ ^th intercostal space, along the left edge of the sternum _____ cm medially laterally

left: in ______ ^th intercostal space, ___ cm medially of left border of relative cardiac dullness

upper: lower edge of the ______ rib.

The width of vascular bundle in the 2^nd costal interspace is _____ cm.

The outline of the heart normal mitral aortal dilated

The right dimension (md) = ____ cm the left dimension (ms) = ____ cm

the diameter of the heart (Т) = ____ cm md: ms = 1÷_____

AUSCULTATION

Heart sounds regular irregular ____ beat per minute

Basic sounds

S1 normal soft muffled loud splitting over apex 4^th point

A2 normal soft accentuated loud splitting

P2 normal soft accentuated loud splitting

Added sounds S3 S4 opening snap

“quail” rhythm “gallop” rhythm presystolic protodiastilic summation

Murmurs present absent

Systolic diastolic early late middiastolic presystolic continious

Location apex 2^nd 3^rd 4^th 5^th points of auscultation

Radiation absence axilla neck back armpit subscapular area

where loudest soft harsh

intensity 1 (very quite) 2 (quite) 3 4 5 6 (audible without stethoscope)

duration short long

effect of position change intensification decrease disappearance

pericardial friction rubs pleuropericardial friction murmurs

Vascular bruits Duroziez’ double "Nun’s murmur" Traube’s doubled tone

Systolic pressure is ______ mm Hg, diastolic pressure is _____ mm Hg, pulse pressure is _____ mm Hg.

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