Cardiology and Cardiothoracic Surgery/Physical Examination of Cardiac Patients

Physical Examination

Physical examination of the cardiac patient, and the cardiac surgical patient, should include thorough evaluations of the cardiac, respiratory, and gastrointestinal systems. For the latter two processes, please consult the respective WikiBooks, Wikipedia pages, and medical texts.

THE CARDIOVASCULAR PHYSICAL EXAM

The cardiovascular physical exam consists, generally, of indirect arterial blood pressure measurement (in both arms and in at least one lower extremity), evaluation of central and peripheral arterial pulses, inspection of the patient, palpation of the precordium, and auscultation. Many clinicians and texts will begin the entire physical examination with inspection; others include arterial blood pressure measurement and pulse evaluation in the vital sign assessment, which is normally conducted prior to the physical examination.

Arterial Pulsation

During clinical examination, the arterial pulsations are normally measured with the patient supine (the head of the examination table should also be tilted upwards by 30-45 degrees) at the carotid arteries, the brachial, radial, and ulnar arteries, the femoral arteries, the popliteal arteries, the posterior tibial arteries, and the dorsalis pedis arteries. Care should be taken in palpation of confirmed stenosed carotid arteries.

The arterial pulse consists of the anacrotic limb (the rapid upstroke of pulsation,) and the relaxation phase, which often ends at an incisura (a small increase in arterial pressure due to increased retrograde resistance resulting from aortic valve closure.

Arterial Pressure

Arterial blood pressure is the measure of lateral force on the arterial walls during the cardiac cycle. The measurement is influenced by arterial end-diastolic volume, blood viscosity, left ventricular ejection velocity, and stroke volume. Note that these factors can also be represented as the mean arterial pressure (MAP) = Cardiac output (CO) X Total peripheral resistance (TPR). Cardiac output is equal to the heart rate multiplied by stroke volume in mL, and TPR is related to blood volume/rheologic properties and peripheral arterial/arteriolar tone. With aging, the mechanical properties of arterial walls change, becoming less compliant, and thus resulting in increased pressure per voxel of blood.

To be continued