Case Presentation - CVS1

a hypothetical CVS case scenario.

a 30yrold male comes in with angina pectoris.

-examine his Apex

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although the case says to examine his "Apex", we are actually required to examine his chest region.

which means this case is synonymous with "examine his chest".

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so what would a chest examination involve?

1. GIEP
2. wash hands
3. inspection of chest
4. palpation of chest
5. auscultation of chest
6. thank, wash hands, leave

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inspection of chest will involve;

1. presence of any scars, swelling, discoloration
2. gross deformities; pectus excavatum/carinatum/kyphoscholiosis/barrel chest
3. no obvious pulsations

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palpation of chest involves

• Palpation of Apex - location and character.
  

  the apex is felt at the --th Left ICS, --cm medial/lateral to the mid clavicular line. there is no tapping nor thrusting.

• palpation of parasternal heave
  ask patient to look left, breath in-out-hold. press hand onto left parasternal border.
• palpation of the 4 quadrants for thrills
  name the 4 areas;
  mitral at the same spot with apex "left 5th ICS 2cm medial to MCL"
  tricuspid "left 4th ICS parasternal border"
  Pulmonic "Left 2nd ICS parasternal border"
  Aortic "right 2nd ICS parasternal border"

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auscultation involves;

• auscultation of the 4 quadrants
  

  S1 and S2 are heard, there were no added heart sounds nor pericardial rub.

  
  

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fin.