Pulse Blood pressure Jugular venous pressure JVP Inspection

Pulse Blood pressure Jugular venous pressure (JVP) Inspection • Bulging procordium (long standing cardiomegaly) • Bulging intercostal spaces (pericardial effusion) • • Dilated veins over the chest Epigastric pulsation Enlargement of heart size Orthopnea

Palpation • • Apex of heart (4 th intercostal space) Thrills (base of the finger) Heave (base of the hand) Radio radial pulse delay Radio femoral pulse delay and Peripheral pulses Temperature

Percussion – Used to outline cardiac borders and to assess the heart size – Pericardial effusion (dullness extends beyond the apex) – Pulmonary hypertension (dullness over the 2 nd left intercostal space which disappears when patient sits up i. e. shifting dullness) – Aortic aneurysm (dullness over right 2 nd intercostal space)

Auscultation – Mitral area (apex) – Tricuspid (above xiphoid cartilage or 3 rd and 4 th left parasternal intercostal spaces) – Aortic area (2 nd intercostal space adjacent to right sternal border) – Pulmonary area (2 nd intercostal space adjacent to left sternal border) Others : – Both sides of the neck (carotid artery bruit, transmitted murmur of AS) – Left axilla (murmur of MR) – Below left mid clavicle in first n second intercostal space (PDA) – Interscapular area in the back of the chest (systolic murmur of coarctation of aorta)

. Carotid artery • Upper limit of the pulsation cannot be defined • With pressure, pulsation becomes more prominent • Respiration has no effect • Hepato – jugular reflex negative JVP • Upper limit of the pulsation cannot be defined • With pressure, pulsations disappear • Inspiration (levels falls down) expiration (comes up) • Hepato – jugular reflex positive