❤️🩹 Cardiovascular System Examination — Terminology .
🪞 1. Inspection – Look
| Term | Explanation |
|---|---|
| Precordium | The area on the front of the chest overlying the heart (left chest wall) |
| Pulsations | Visible throbbing movements — may be normal at the apex but abnormal elsewhere |
| Apical impulse | Visible or palpable heartbeat in the 5th intercostal space, midclavicular line — normally mild and focused |
| Heaving impulse | Strong and forceful apical beat — suggests left ventricular hypertrophy (LVH) |
| Parasternal heave | Outward thrust felt at the left sternal border — suggests right ventricular hypertrophy (RVH) |
| Jugular venous pulsation (JVP) | Visible wave-like movement in the neck veins caused by blood returning to the right atrium |
| Cyanosis | Bluish discoloration of lips, tongue, or extremities — indicates low oxygen levels |
| Clubbing | Bulbous enlargement of fingertips — may occur in congenital heart disease or infective endocarditis |
| Edema | Swelling, especially in legs — suggests fluid retention, often from heart failure |
✋ 2. Palpation – Feel
| Term | Explanation |
|---|---|
| Apex beat | The point where the heart’s contraction is felt most strongly — normally in the 5th intercostal space, midclavicular line |
| Displaced apex beat | Apex felt more lateral or inferior — indicates enlarged heart (cardiomegaly) |
| Heaving apex | Sustained and forceful — suggests pressure overload (like in aortic stenosis) |
| Thrusting apex | Hyperdynamic, tapping, or bounding — seen in volume overload (like mitral regurgitation) |
| Thrill | A palpable vibration — felt over turbulent blood flow, e.g., over a murmur-producing valve |
| Parasternal heave | A forceful lifting of the chest wall — indicates right ventricular enlargement |
| Peripheral pulses | Pulses felt at wrist (radial), neck (carotid), feet (dorsalis pedis/posterior tibial) to assess rhythm, rate, and volume |
| Pulse deficit | Difference between apical and peripheral pulse rate — seen in atrial fibrillation |
| Capillary refill time (CRT) | Time taken for color to return after pressing nail bed — normal <2 seconds; delayed in shock |
🫳 3. Percussion – Tap
| Term | Explanation |
|---|---|
| Cardiac dullness | Dull sound heard when tapping over the heart — helps estimate heart size (now rarely done due to imaging) |
| Percussion note | Sound generated when tapping — resonant over lungs, dull over the heart |
🎧 4. Auscultation – Listen
| Term | Explanation |
|---|---|
| Heart sounds | Sounds produced by closing of valves |
| S1 (First Heart Sound) | "Lub" — Closure of mitral and tricuspid valves — marks start of systole |
| S2 (Second Heart Sound) | "Dub" — Closure of aortic and pulmonary valves — marks end of systole/start of diastole |
| S3 | Extra sound in early diastole — normal in children/athletes; pathological in heart failure |
| S4 | Extra sound in late diastole — indicates stiff ventricle (e.g., hypertension, aortic stenosis) |
| Murmur | Abnormal, prolonged heart sound due to turbulent flow — can be systolic or diastolic |
| Ejection click | High-pitched sound just after S1 — heard in aortic or pulmonary stenosis |
| Opening snap | Sharp sound in early diastole — heard in mitral stenosis |
| Pericardial rub | Scratching/grating sound — due to inflamed pericardium (pericarditis) |
| Gallop rhythm | Presence of S3 or S4 — sounds like a horse’s gallop; sign of heart failure |
🩺 Auscultation Areas (Valvular Points)
| Valve | Location for auscultation |
|---|---|
| Aortic valve | 2nd right intercostal space, just next to sternum |
Pulmonary valve |
2nd left intercostal space, next to sternum |
Tricuspid valve |
4th or 5th left intercostal space, close to sternum |
| Mitral valve | 5th left intercostal space, midclavicular line (apex area) |
🫀 Pulse Characteristics
| Term | Explanation |
|---|---|
| Bounding pulse | Strong, forceful pulse — in high output states (fever, anemia) |
| Thready pulse | Weak, thin pulse — seen in shock |
Irregularly irregular pulse |
No pattern at all — classic in atrial fibrillation |
Pulsus paradoxus |
Drop in systolic BP during inspiration >10 mmHg — seen in cardiac tamponade |
Pulsus alternans |
Alternating strong and weak pulse beats — in severe left ventricular failure |
| Radio-femoral delay | Radial and femoral pulse not felt together — seen in coarctation of the aorta |
🧠 Common Pathological Terms in CVS
| Term | Explanation |
|---|---|
| Mitral stenosis | Narrowing of mitral valve — leads to obstructed blood flow from left atrium to left ventricle |
Aortic regurgitation |
Aortic valve leaks blood back into the left ventricle |
Heart failure |
Heart’s inability to pump blood effectively |
| Cardiomyopathy | Disease of the heart muscle affecting function |
| Pericarditis | Inflammation of the membrane around the heart |
| Endocarditis | Infection of the inner lining/valves of the heart |
Myocardial infarction |
Heart attack — damage due to blocked coronary arteries |
Congenital heart disease |
Heart defect present from birth (e.g., ASD, VSD, TOF) |
📚 Summary Tip:
- S1 = AV valves close, S2 = semilunar valves close
- Systolic murmur between S1–S2 (e.g., aortic stenosis)
- Diastolic murmur after S2 (e.g., mitral stenosis)
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