13.13: Cardiovascular System Abnormal Findings I: Inspection and Palpation

In a cardiovascular examination, inspection and palpation are crucial for identifying abnormalities.

Abnormal findings observed during an inspection

1. General Appearance: Observe the patient's general appearance, noting body build and signs of distress, shortness of breath, or anxiety. Changes in consciousness and mental status can indicate inadequate brain perfusion.
2. Xanthelasma: Yellowish raised deposits on the nasal portion of the eyelids indicate elevated cholesterol levels.
3. Central Cyanosis: A bluish or purplish tinge found in mucous membranes, including the tongue, gums, lips, and conjunctiva, arterial blood oxygen saturation, often due to pulmonary or cardiac disorders.
4. Clubbing of Nail Beds: Loss of the normal angle between the base of the nail and the skin is associated with endocarditis, congenital defects, and prolonged oxygen deficiency.
5. Color Changes in Extremities with Postural Change: Look for pallor, cyanosis, and mottling after limb elevation. Dependent rubor indicates chronic decreased arterial perfusion.
6. Jugular Venous Distention (JVD): Distended neck veins at a 30- to 45-degree angle suggest increased right atrial pressure and right-sided heart failure.
7. Peripheral Cyanosis: A bluish or purplish tinge in the extremities, nose, and ears results from decreased blood flow due to heart failure, vasoconstriction, or cold.
8. Splinter Hemorrhages: Small red to black streaks under the fingernails indicate infective endocarditis.
9. Ulcers: Venous ulcers at the medial malleolus and arterial ulcers on toes, heels, and lateral malleoli indicate poor venous return and arteriosclerosis, respectively.
10. Varicose Veins: Dilated, discolored, tortuous vessels in the legs suggest incompetent venous valves.
11. Hematoma: Localized swelling filled with clotted blood, typically due to trauma or vascular injury.
12. Cold Extremities: Cold hands or feet indicate poor arterial perfusion or severe anemia.

Abnormal findings observed during palpation

Pulse abnormal findings

1. Bradycardia: Less than 60 beats per minute.
2. Tachycardia: Greater than 100 beats per minute.
3. Absent Pulse: Indicates local atherosclerosis, trauma, or embolus.
4. Bounding Pulse: A sharp, brisk pulse seen in hyperkinetic states, anemia, or hyperthyroidism.
5. Irregular Pulse: Regularly irregular or irregularly irregular beats indicate dysrhythmias.
6. Pulsus Alternans: Alternating pulse strength suggests heart failure or cardiac tamponade.
7. Thready Pulse: A weak, easily obliterated pulse indicating blood loss, decreased cardiac output, or peripheral arterial disease.

Thrill: A palpable vibration indicating turbulent blood flow from conditions like aneurysm or aortic regurgitation at the left sternal edge.

Heaves: Heaves are broad, forceful apical impulses indicating left ventricular heave. Thrills are vibrations felt over areas of turbulent blood flow associated with loud murmurs and valvular heart disease at the left sternal edge.

Point of Maximal Impulse (PMI): Locate the PMI at the fifth intercostal space in the midclavicular line. A laterally displaced or enlarged PMI indicates cardiac enlargement.

Capillary Refill: Assess capillary refill by squeezing the nail bed briefly. A normal refill takes less than 2 seconds; a prolonged refill suggests compromised arterial perfusion.

Pitting Edema: Check for pitting edema by pressing the skin over the tibia or medial malleolus. Pitting edema ranges from 1+ (mild) to 4+ (severe).