The Cardiovascular Exam / Heart Sounds (Strong Exam)

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 pulse (1957): Entire title  

Stethoscope: Stethoscope 1.jpg uploaded to Wikimedia Commons by user Ernstl under CC BY SA 2.0. Downloaded February 2024.

#physicalexam #cardiology #OSCE