Among all the clinical stations in Internal Medicine, cardiovascular system examination is an attractive station for students as they are able to appreciate dynamic findings and can diagnose disease along with severity and complications almost with certainty.
If you are preparing for this station, here are a few DOs and DON’Ts that shall further help you in preparation for the exams. Follow these DOs & stay away from DON’Ts to sail smoothly!
– Start with a general physical examination related to CVS. Peripheral signs give valuable clues as to what you are going to find once you reach precordial examination.
– Try not to miss findings, if any, in hands and face. These two are like a key-hole to peep in the heart as to what is going on there. e.g., Quincke’s sign suggests hyperdynamic circulation in AR, and Malar flush suggest Mitral stenosis.
– Concentrate on pulse rhythm, character and volume. But comment on volume after checking carotid pulse.
– Ask about pain/discomfort or shoulder joint problems before raising the patient’s arm to check a collapsing pulse.
– Do not forget to auscultate carotids for bruit before pressing carotid to check pulse volume and to time pulse with the murmur.
– Do not press too hard to find carotids. It should be easy to feel them.
– You only need to check one side carotid mainly the right side. But if for any reason you need to check both, DO NOT press both carotids simultaneously.
– Do not forget to determine the details/findings of normal heart sounds before jumping on to murmurs. Students are tempted to pick murmur and forget normal heart sounds. Finding a murmur is important but not the sole part of an examination.
– Do manoeuvres of murmur accentuation. When you appreciate a diastolic murmur, do the manoeuvers to accentuate it.
– Ask about pain abdomen before palpating for hepatomegaly. Stay gentle in palpation since hepatomegaly with cardiovascular system examination is expected to be tender (i.e., congestive hepatomegaly).
– If you come across a sternal scar, don’t forget to check for graft scars on legs when looking for pedal oedema. It gives important clue to differentiate between CABG and a valvular surgery where there is only an operative scar on the sternum.
– Do not forget to check 2 things on the back.
i) Auscultating lungs for pulmonary oedema
ii) Sacral oedema
– Last but not least, Don’t make up the findings which were not there.
Print & Keep it as a checklist to judge yourself on how many points you fulfil.