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.

#physicalexam #cardiology #OSCE

[StrongMed]

I appreciate everyone's patience for this video! It took an unusually long time to edit, and came at an unusually busy period for me for patient care.

A few additional comments:


- I appreciate that some clinicians argue for carotid auscultation to be relegated to the "archaic" maneuver category that we should no longer be teaching everyone. This position is most succinctly outlined in the Aronson paper listed in the above references. In extreme brief, the argument is basically that screening for, confirming via ultrasound or CT angiogram, and "fixing" asymptomatic carotid obstructions initially identified via hearing bruits leads to only small, non-cost-effective benefit. I don't know if the evidence fully supports that position. However, even if it does, patients with carotid bruits do have significantly increased rates of overall cardiovascular death, demonstrating that it's a general marker for atherosclerosis. Therefore, the presence of a carotid bruit could reasonably shift one's threshold for more aggressively treating hypertension or hyperlipidemia in a similar way to prediabetes, obesity or a sedentary lifestyle.

[fjaramillo]

thank you dr strong, the cuality of your videos has improved immensely

[mr.medtech]

physical exam videos are much needed. I'm OMS2 about to enter rotations and these videos will help me improve my clinical skills

[waelfadlallah]

I have waited for this for a long time

[inga]

Thank you, Dr. Strong! I can see you've got a real passion for the medicine, unlike quite a number of other doctors I happened to come across.

[dizzyboy]

Excellent video, waiting excitedly for the abdominal video.

[rutza]

Thanks a lot! This is a great video, well explained for health care workers, especially the nurses like me who plan to return back to school

[terezinmorocco]

Thank you, Dr. Strong! This will help me for next week’s head to toe midterm demonstration 😊

[DrRkd]

Impressed and equally felt happy that you people cares so much about ethics 😊

[navneetjuneja]

Thank you so much Dr Strong, Kindly Upload for Respiratory, Neurological and MSK examination too 🙏

[vladyslavshapoval]

Дякую, дивлюся вас з України, дуже допомогає пояснити студентам базові аспекти! Дякую ❤

[anilkarameti]

@StrongMed Doctor, does stethoscope really matter during auscultation? In other words, is a 20 dollar stethoscope the same as a Litmann Cardiology IV (220 dollar) when it comes to auscultation?

[MuhammadAhsan-mphq]

Sir kindly upload video on abdomen exam😢😢😢

[skyemac]

Landmarking interstitial spaces/ribs is my real weakness on some people.

[DannyMercer]

Pitting oedema
Pregnancy and Pills
Infected (cellulitis) and impairment (heart, liver, kidney)
TED
Stasis (CVS), starvation

[zuhairyassin]

cant we appreciate pocus echo for valve assessment auscultation will be an indication for an echo why not to echo the patient