1. PULSE EXAMINATION
- Best Felt at:
Radial artery
- Other Sites:
Carotid, Brachial, Femoral, Popliteal, Dorsalis Pedis, Posterior Tibial
Mnemonic:
"Can Boys Feel Proper Doctors' Pulses?"
- Carotid
- Brachial
- Femoral
- Popliteal
- Dorsalis
Pedis
- Posterior
Tibial
Types of Pulse
& Their Significance
|
Pulse Type |
Meaning |
Mnemonic |
|
Collapsing
(Water-Hammer) Pulse |
Aortic
regurgitation |
"Collapsing
Water" |
|
Pulsus Parvus et
Tardus |
Aortic
stenosis (Low & Slow) |
"Parvus (Poor)
& Tardus (Tardy)" |
|
Pulsus Alternans |
LV Failure
(Alternating Strong-Weak beats) |
"ALTERNate LV
failure" |
|
Pulsus Paradoxus |
Cardiac Tamponade (↓
BP on Inspiration) |
"Paradox in
Pericarditis" |
|
Pulsus Bigeminus |
Every 2nd Beat
Premature (Extrasystole) |
"BIGEMINI = 2
beats" |
|
Dicrotic Pulse |
High
fever, Sepsis |
"D for
DICROTIC & DISEASE" |
|
Bisferiens Pulse |
Aortic
Stenosis + Regurgitation (Double Beat) |
"BI-2
Peaks" |
2. BLOOD PRESSURE
(BP) MEASUREMENT
- Systolic BP
= Cardiac Output (CO)
- Diastolic BP
= Peripheral Resistance (PR)
Normal BP = 120/80 mmHg
Hypertension = ≥ 140/90 mmHg
Hypotension = ≤ 90/60 mmHg
3. PRECORDIAL
EXAMINATION
Inspection (LOOK)
- Apex Beat
→ Normally in 5th intercostal space, Mid-Clavicular Line
- Chest Deformity
→ Precordial bulging = Cardiomegaly
- Visible Pulsations
→ RV enlargement (3rd & 4th left ICS), Aortic Aneurysm
(Suprasternal Notch)
Mnemonic:
"ABC" for Apex Beat
- A = Apex
in 5th ICS
- B = Bulging
chest = Cardiomegaly
- C = Check
for visible pulsations
Palpation (FEEL)
Apex Beat
Thrills (Vibration due to murmurs)
Right Ventricular Heave (Pulmonary Hypertension)
Pulmonary & Aortic Pulsations
Percussion (TAP)
• Helps locate heart borders
• Left border starts from Left Anterior Axillary Line
(Medially percuss)
• Right border hard to define unless Right Atrium is enlarged
Auscultation
(LISTEN)
Heart Sounds Heard At:
|
Valve Area |
Location |
Mnemonic |
|
Mitral |
Apex (5th ICS, MCL) |
"M is for
MCL" |
|
Tricuspid |
Left 5th ICS, near Sternum |
"T for
Tricuspid = T for sTernum" |
|
Pulmonary |
Left 2nd ICS,
lateral to Sternum |
"P for
Pulmonary = P for Parasternally" |
|
Aortic (1st area) |
Right 2nd ICS,
lateral to Sternum |
"A for Aorta =
A for Away (right side)" |
|
Aortic (2nd area) |
Left 3rd ICS, Parasternally
(Erb’s Point) |
"Aortic 2nd =
3rd ICS (Erb's)" |
Heart Sounds
(S1-S2-S3-S4)
S1 ("Lub") → Mitral & Tricuspid Close
S2 ("Dub") → Aortic & Pulmonary Close
S3 (Gallop Sound) → Heart Failure
S4 (Atrial Contraction Sound) → Hypertrophy
Mnemonic:
"LUB DUB Gallop"
- S1 = Lub
- S2 = Dub
- S3 = Gallop (Heart Failure)
4. COMMON CVS
FINDINGS & ASSOCIATED DISEASES
|
Finding |
Disease |
Mnemonic |
|
Apex Beat Displaced |
Cardiomegaly |
"Big Heart =
Big Beat" |
|
Tapping Apex Beat |
Mitral
Stenosis |
"MS Taps
Hard" |
|
Heaving Apex Beat |
Aortic
Stenosis, Hypertension |
"AS Hypes
Up" |
|
Right Ventricular
Heave |
Pulmonary
Hypertension |
"Right side =
Pulmonary" |
FINAL REVISION WITH MNEMONICS
- Pulse Sites → "Can Boys Feel Proper Doctors' Pulses?"
- Murmurs → "MR AS, MS AR"
- Heart Sounds → "Lub-Dub-Gallop"
- BP Formula → "BP = CO × PR"
- Auscultation Areas → "M T P A" (Mitral, Tricuspid, Pulmonary, Aortic)