The Cardiovascular Exam / Heart Sounds (Strong Exam)
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- Опубліковано 31 тра 2024
- A deep dive on the "core" cardiovascular exam - the exam of the heart and blood vessels that one would perform on a new primary care patient, or on a patient being admitted to the hospital for an issue not directly related to the heart. I discuss pulses, edema, JVP, carotid bruits, and heart sounds and murmurs.
0:00 Introduction
1:06 Review of anatomy
4:11 Pulses
11:56 Edema
15:21 JVP
27:05 Carotid auscultation
28:44 Cardiac auscultation
43:46 Documentation
References:
McGee S. Evidence Based Physical Diagnosis. 5th Ed. Elsevier; 2021.
Constant J. Bedside Cardiology. 5th Ed. Lippincott, Williams & Wilkins; 1999.
Bloomfield RA, et al. Recording of Right Heart Pressures in Normal Subjects and in Patients with Chronic Pulmonary Disease and Various Types of Cardio-Circulatory Disease. J Clin Invest. 1946;25:639-664.
Sauve JS, et al. The Rational Clinical Examination. Does This Patient Have a Clinically Important Carotid Bruit? JAMA. 1993; 270:2843-2845.
Heyman A, et al. Risk of Stroke in Asymptomatic Persons with Cervical Arterial Bruits. NEJM. 1980; 302:838-841.
Aronson L, Landefeld CS. Examining Older People for Carotid Bruits: Listen To Your Patient, Not Her Neck. J Gen Intern Med. 1998; 13:140-141.
McColgan P, et al. Evaluation of the Clinical Utility of a Carotid Bruit. Q J Med. 2012; 105:1171-1177.
Pickett CA, et al. Carotid Bruits and Cerebrovascular Disease Risk: A Meta-Analysis. Stroke. 2010; 41:2295-2302.
Wang CS, et al. Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure? JAMA. 2005; 294:1944-1956.
Etchells E, Bell C, Robb K. Does This Patient Have an Abnormal Systolic Murmur? JAMA. 1997; 277:564-571.
Additional image & video credits:
Rib cage: Adapted from Gray's Anatomy. In Public Domain.
Heart: Heart model.png uploaded to Wikimedia Commons by BruceBlaus. Downloaded February 2024.
JVP demonstration: The Jugular Venous Pulse (1957). Provided by the Wellcome Collection under CC BY NC 4.0. • The jugular venous pul...
Stethoscope: Stethoscope 1.jpg uploaded to Wikimedia Commons by user Ernstl under CC BY SA 2.0. Downloaded February 2024.
#physicalexam #cardiology #OSCE
I appreciate everyone's patience for this video! It took an unusually long time to edit, and came at an unusually busy period for me for patient care.
A few additional comments:
- Unfortunately, my patient was an example of how not everyone's JVP is equally clear as a demonstration of how JVP is "supposed to" look like. For some great examples of both normal and abnormal JVP, I suggest: physicaldiagnosispdx.com/card-tutorial/#Jugular_Venous_Pulse
- I appreciate that some clinicians argue for carotid auscultation to be relegated to the "archaic" maneuver category that we should no longer be teaching everyone. This position is most succinctly outlined in the Aronson paper listed in the above references. In extreme brief, the argument is basically that screening for, confirming via ultrasound or CT angiogram, and "fixing" asymptomatic carotid obstructions initially identified via hearing bruits leads to only small, non-cost-effective benefit. I don't know if the evidence fully supports that position. However, even if it does, patients with carotid bruits do have significantly increased rates of overall cardiovascular death, demonstrating that it's a general marker for atherosclerosis. Therefore, the presence of a carotid bruit could reasonably shift one's threshold for more aggressively treating hypertension or hyperlipidemia in a similar way to prediabetes, obesity or a sedentary lifestyle.
thank you dr strong, the cuality of your videos has improved immensely
Thanks! Unfortunately, the time that it takes to makes these has also increased immensely! ;)
physical exam videos are much needed. I'm OMS2 about to enter rotations and these videos will help me improve my clinical skills
Excellent video, waiting excitedly for the abdominal video.
I have waited for this for a long time
Absolutely amazing
Thanks a lot! This is a great video, well explained for health care workers, especially the nurses like me who plan to return back to school
Thank you for the great content!
Well detailed
Landmarking interstitial spaces/ribs is my real weakness on some people.
Thank you so much Dr Strong, Kindly Upload for Respiratory, Neurological and MSK examination too 🙏
Respiratory (i.e. pulmonary) exam is already posted. The others will be a while since our med school is currently enforcing face masks for all patient and standardized patient encounters.
Thankssss
impatiently waiting for abdomen exam
Sir kindly upload video on abdomen exam😢😢😢
Don't worry, it's coming!
Pitting oedema
Pregnancy and Pills
Infected (cellulitis) and impairment (heart, liver, kidney)
TED
Stasis (CVS), starvation
cant we appreciate pocus echo for valve assessment auscultation will be an indication for an echo why not to echo the patient