Let's study Medical English. CHEST PAIN.P2
I see your blood pressure is 150 over 95 and your heart rate is 95 today. These are both somewhat elevated. I would like to begin by examining your lips and nails for color and then listen to your lungs.
Okay.
Examine lips and nails for cyanosis.
Okay, looks good.
Percuss then auscultate posterior lungs in ladder pattern.
Take a deep breath.
Listen to the lungs making sure to listen to the right middle lobe under axilla.
One more time.
[BREATHING IN AND OUT]
I’ll be examining the vessels in your neck, and then your heart. So please lie back with your feet straight out.
Examine the neck first.
Assess the jugular venous pressure.
Find the highest point of oscillation in the internal jugular vein……and measure the vertical distance from the sternal angle.
Palpate carotid upstroke.
The normal upstroke is brisk, smooth, and rapid, and follows S1 almost immediately.
Large bounding upstrokes indicate aortic insufficiency.
Listen for a bruit, which is a whooshing, murmur‐like sound often from atherosclerotic narrowing of the carotid artery. A bruit sound like this:
[BRUIT, WHOOSHING MURMUR]
Okay, I’m going to check the tapping impulse point of your heart.
Palpate the point of maximal impulse. You can do this and listen to the heart sounds by listening under the gown without exposing the chest.
You may notice “tapping” which is timed at the beginning of systole. The point of maximal impulse may be sustained or diffuse, meaning spread over more than one intercostal space.
Listen for S1 and S2 in each of the six listening areas: in the aortic area in the right second interspace close to the sternum; in the pulmonic area in the left second interspace close to the sternum; in the left third interspace; in the tricuspid area in the left fourth and left fifth interspaces; and in the mitral area at the apex.
Use the diaphragm at the right upper sternal border and the lower left sternal border.
Use the bell at the apex.
Listen to and palpate the abdomen.
The following findings may be heard in the cardiac auscultation of this patient. Can you identify these heart sounds?
[HEARTBEAT]
S4 is a low pitched diastolic sound reflecting changes in ventricular compliance, best heard with the bell with the patient in a left lateral decubitus position. It may be present during ischemia or in the setting of hypertension.
Identify these heart sounds.
[HEARTBEAT]
Mitral regurgitation is a holosystolic murmur reflecting mitral valve dilatation, best heard at the apex that may radiate to the axilla and lower left sternal border. It may occur with transient ischemia.
Assess congestive heart failure (CHF) in patients with extensive myocardial infarction that compromises cardiac output due to decreased stroke volume or heart rate.
Which findings on the cardiac exam have the best evidence for congestive heart failure?
Rales, an elevated JVP, and an S3 consistently predict heart failure.
[HEARTBEAT]
S3 is a low‐pitched diastolic sound reflecting changed ventricular compliance, best heard with the bell with the patient in a left lateral decubitus position.
Palpate the ankles for edema.
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13/11/2022
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