Badanie fizykalne Układu Sercowo-Naczyniowego | Cardiovascular System Examination

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failure”: “Niewydolność serca”, “Nail beds”: “Łożyska paznokciowe”, “Pallor”: “Bladość”, “Reduced arterial blood flow”: “Zmniejszony przepływ krwi tętniczej”, “Systemic conditions”: “Stany ogólnoustrojowe”, “Severe anemia”: “Ciężka niedokrwistość”, “Varicose veins”: “Żylaki”, “Chronic venous insufficiency”: “Przewlekła niewydolność żylna”, “Tortuous veins”: “Kręte żyły”, “Dilated veins”: “Rozszerzone żyły”, “Dependent pattern”: “Zależny wzór obrzęku”, “Lymphatic obstruction”: “Zastój limfatyczny”, “Systemic fluid overload”: “Przeciążenie płynami ustrojowymi”, “Venous ulcers”: “Owrzodzenia żylne”, “Arterial ulcers”: “Owrzodzenia tętnicze”, “Non-healing”: “Niegojące się”, “Peripheral pulses”: “Tętno obwodowe”, “Arterial assessment”: “Ocena tętnic”, “Bilateral comparison”: “Porównanie obustronne”, “Carotid pulse”: “Tętno na tętnicy szyjnej”, “Brachial pulse”: “Tętno na tętnicy ramiennej”, “Radial pulse”: “Tętno na tętnicy promieniowej”, “Femoral pulse”: “Tętno na tętnicy udowej”, “Popliteal pulse”: “Tętno na tętnicy podkolanowej”, “Dorsalis pedis pulse”: “Tętno na tętnicy grzbietowej stopy”, “Posterior tibial pulse”: “Tętno na tętnicy piszczelowej tylnej”, “Arterial occlusion”: “Niedrożność tętnicza”, “Capillary refill time”: “Czas powrotu włośniczkowego”, “Delayed refill”: “Opóźniony powrót”, “Peripheral perfusion”: “Perfuzja obwodowa”, “Hypovolemia”: “Hipowolemia”, “Shock”: “Wstrząs”, “Tenderness”: “Tkliwość”, “Superficial thrombophlebitis”: “Zakrzepowe zapalenie żył powierzchownych”, “Inflamed vein”: “Zapalenie żyły”, “Pitting edema”: “Obrzęk ciastowaty”, “Non-pitting edema”: “Obrzęk nieciastowaty”, “Lymphedema”: “Obrzęk limfatyczny”, “Hypothyroidism”: “Niedoczynność tarczycy”, “Auscultation”: “Osłuchiwanie”, “Bruits”: “Szmer naczyniowy”, “Turbulent blood flow”: “Burzliwy przepływ krwi”, “Narrowed arteries”: “Zwężone tętnice”, “Partially blocked arteries”: “Częściowo zablokowane tętnice”, “Carotid artery stenosis”: “Zwężenie tętnicy szyjnej”, “Abdominal aorta”: “Aorta brzuszna”, “Aortic aneurysm”: “Tętniak aorty”, “Renal artery stenosis”: “Zwężenie tętnicy nerkowej”, “Peripheral arterial disease”: “Choroba tętnic obwodowych”, “Doppler ultrasound”: “Ultrasonografia Dopplerowska”, “Angiography”: “Angiografia”, “Blood pressure measurement”: “Pomiar ciśnienia krwi”, “Hypertension”: “Nadciśnienie tętnicze”, “Hypotension”: “Niedociśnienie tętnicze”, “Sphygmomanometer”: “Ciśnieniomierz”, “Orthostatic hypotension”: “Hipotonia ortostatyczna”, “Blood pressure categories”: “Kategorie ciśnienia krwi”, “Isolated systolic hypertension”: “Izolowane nadciśnienie skurczowe”, “Hypertensive crisis”: “Przełom nadciśnieniowy”, “Silent killer”: “Cichy zabójca”, “Dehydration”: “Odwodnienie”, “Blood loss”: “Utrata krwi”, “Autonomic dysfunction”: “Dysfunkcja autonomiczna”, “Venous system examination”: “Badanie układu żylnego”, “Arterial system examination”: “Badanie układu tętniczego”, “Venous insufficiency”: “Niewydolność żylna”, “Valve incompetency”: “Niewydolność zastawek”, “Venous thrombosis”: “Zakrzepica żylna”, “Stasis dermatitis”: “Zapalenie skóry zastoinowe”, “Dependent rubor”: “Rumień zależny”, “Ankle-Brachial Index”: “Wskaźnik kostkowo-ramienny”, “Manual Compression Test”: “Test ucisku manualnego”, “Trendelenburg Test”: “Test Trendelenburga”, “Venous hums”: “Szmer żylny”, “Vascular anomalies”: “Anomalie naczyniowe”, “Palms”: “Dłonie”, “Mucous membranes”: “Błony śluzowe”, “Advanced”: “Zaawansowany”, “Heaviness”: “Uczucie ciężkości”, “Aching”: “Ból”, “Swelling”: “Obrzęk”, “Edema”: “Obrzęk”, “Ulcers”: “Owrzodzenia”, “Well-demarcated”: “Wyraźnie odgraniczone”, “Severe arterial disease”: “Ciężka choroba tętnicza”, “Palpation”: “Palpacja”, “Fluid retention”: “Zatrzymanie płynów”, “Inflammation”: “Zapalenie”, “Carotid arteries”: “Tętnice szyjne”, “Thrills”: “Mruki”, “Diminished”: “Osłabiony”, “Aortic”: “Aortalny”, “Iliac”: “Biodrowy”, “Clot”: “Skrzeplina”, “Carotid Arteries”: “Tętnice szyjne”, “Stenosis”: “Zwężenie”, “Branches”: “Gałęzie”, “Groin area”: “Okolica pachwinowa”, “Femoral bruit”: “Szmer naczyniowy nad tętnicą udową”, “Vascular stenosis”: “Zwężenie naczyniowe”, “Aneurysm”: “Tętniak”, “Underlying cause”: “Przyczyna podstawowa”, “Cuff Placement”: “Umiejscowienie mankietu”, “Auscultatory Method”: “Metoda osłuchowa”, “Systolic”: “Skurczowe”, “Diastolic”: “Rozkurczowe”, “Stroke”: “Udar mózgu”, “Heart attack”: “Zawał serca”, “Kidney failure”: “Niewydolność nerek”, “Dizziness”: “Zawroty głowy”, “Fainting”: “Omdlenie”, “Thrombosis”: “Zakrzepica”, “Arterial blood flow”: “Przepływ krwi tętniczej”, “Occlusion”: “Zamknięcie”, “Insufficiency”: “Niewydolność”, “Superficial veins”: “Żyły powierzchowne”, “Thrombophlebitis”: “Zakrzepowe zapalenie żył”, “Femoral”: “Udowy”, “Dorsalis pedis”: “Tętnica grzbietowa stopy”, “Venous valve”: “Zastawka żylna”, “PAD”: “Choroba tętnic obwodowych”, “Renal”: “Nerkowy”, “Carotid”: “Szyjny”, “Aneurysms”: “Tętniaki” }; // Normalize keys in the dictionary const 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Szacowany czas lekcji: 18 minut
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Observation

During the initial inspection, carefully observe for signs that may suggest vascular diseases. This visual assessment provides crucial initial clues about the patient’s vascular health.

  • Peripheral Cyanosis: Look for a bluish discoloration of the extremities, which indicates inadequate oxygenation of the blood in the peripheral circulation. This is typically seen in severe arterial insufficiency or advanced heart failure. Pay close attention to the tips of the fingers, toes, and nail beds.
  • Pallor: Assess for pale skin, which may be a sign of reduced arterial blood flow due to occlusion or systemic conditions such as severe anemia. Check for pallor in areas such as the palms, nail beds, and mucous membranes.
  • Varicose Veins: Inspect the lower extremities for visible, tortuous, and dilated veins, indicating chronic venous insufficiency. Patients may also complain of heaviness, aching, or swelling in their legs, which worsens with prolonged standing or sitting.
  • Edema: Swelling in the lower extremities which may indicate chronic venous insufficiency, lymphatic obstruction, or systemic fluid overload.
  • Ulcers: Inspect the skin for non-healing ulcers:
    1. Venous Ulcers: Irregular, shallow, and often found around the ankles, indicating chronic venous insufficiency.
    2. Arterial Ulcers: Painful, well-demarcated, and typically located on the toes or bony prominences, suggesting severe arterial disease.

Palpation

Palpation provides essential information about both the arterial and venous systems. The goal is to assess the strength of pulses, the presence of tenderness, and signs of fluid retention or inflammation.

Peripheral Pulses (Arterial Assessment)

Palpate major arteries to evaluate the strength, rhythm, and symmetry of blood flow. Ensure to compare pulses bilaterally:

  • Carotid Pulse: Palpate one side at a time, being careful not to compress both carotid arteries simultaneously to avoid reducing blood flow to the brain. Assess for strength, symmetry, and the presence of any thrills, which may indicate turbulence.
  • Brachial Pulse: Located in the antecubital fossa, this pulse is useful for assessing blood pressure and detecting abnormalities in arterial flow to the upper extremities.
  • Radial Pulse: Evaluate the rate, rhythm, and amplitude. Weak or absent radial pulses may indicate arterial occlusion or reduced arterial blood flow to the hand.
  • Femoral Pulse: Located in the groin area, this pulse helps assess for adequate blood flow from the abdominal aorta to the lower extremities. A diminished or absent femoral pulse may be indicative of significant aortic or iliac artery disease.
  • Popliteal Pulse: Found behind the knee, the popliteal pulse is often difficult to palpate. A weak or absent pulse here may suggest femoral artery disease or other forms of arterial insufficiency.
  • Dorsalis Pedis and Posterior Tibial Pulses: These pulses are critical in evaluating peripheral arterial disease (PAD) in the lower extremities. Absence or asymmetry of these pulses can indicate compromised arterial circulation.

Capillary Refill Time (Arterial Indicator)

  • Normal: Less than 2 seconds, indicating adequate arterial blood flow to the extremities.
  • Delayed Refill: If capillary refill takes more than 2 seconds, it suggests poor peripheral perfusion, which may indicate conditions such as hypovolemia, shock, or peripheral arterial disease.

Venous System Palpation

  • Tenderness: Palpate along the veins for tenderness, which may indicate superficial thrombophlebitis, where a superficial vein becomes inflamed and painful due to a clot. Note the exact location of tenderness.
  • Edema: Assess for the type and distribution of edema:
    1. Pitting Edema: Press the skin over the tibia or the top of the foot. If an indentation remains, it suggests fluid accumulation, commonly due to venous insufficiency or right-sided heart failure.
    2. Non-Pitting Edema: Usually seen in conditions like lymphedema or hypothyroidism, where the skin does not leave an indentation when pressed.

Auscultation

Auscultation is crucial for detecting vascular abnormalities, such as bruits, which signify turbulent blood flow through narrowed or partially blocked arteries.

Common Sites for Auscultation of Bruits

  • Carotid Arteries: Use the bell of the stethoscope to listen for bruits, which may indicate carotid artery stenosis. Ask the patient to hold their breath briefly during auscultation to minimize noise.
  • Abdominal Aorta: Listen for bruits over the aorta in the abdomen, which may indicate an aortic aneurysm or stenosis of its branches.
  • Renal Arteries: Auscultate in the flank area for bruits, which can suggest renal artery stenosis, a cause of secondary hypertension.
  • Femoral Arteries: Listen for bruits in the groin area. Presence of a femoral bruit may indicate peripheral arterial disease.

Bruits

  • Description: A bruit is a whooshing or blowing sound heard over arteries, caused by turbulent blood flow. It may indicate vascular stenosis or an aneurysm.
  • Clinical Significance: The detection of bruits often warrants further imaging, such as Doppler ultrasound or angiography, to evaluate the underlying cause.

Blood Pressure Measurement

Accurate blood pressure measurement is vital for assessing vascular health and diagnosing hypertension or hypotension:

  1. Cuff Placement: Use an appropriately sized cuff. Place it on the upper arm, ensuring the cuff is snug and positioned at heart level.
  2. Auscultatory Method: Use a stethoscope and sphygmomanometer to measure systolic and diastolic pressures accurately.
  3. Orthostatic Hypotension: Assess blood pressure changes when the patient transitions from lying down to standing. A drop in systolic pressure of 20 mm Hg or more, or in diastolic pressure of 10 mm Hg or more, may indicate orthostatic hypotension, commonly caused by dehydration, blood loss, or autonomic dysfunction.

Blood Pressure Values

Blood Pressure CategorySystolic (mm Hg)and/orDiastolic (mm Hg)
Normal<120and<80
Elevated120 – 129and<80
Hypertension Stage 1130 – 139or80 – 89
Hypertension Stage 2≥140or≥90
Isolated Systolic Hypertension≥140and<90
Hypertensive Crisis >180and/or>120
Hypotension<90and/or<60
  • Hypertension: Often asymptomatic and called the “silent killer,” it requires treatment to prevent serious complications like stroke, heart attack, and kidney failure.
  • Hypotension: Can present with symptoms like dizziness, fainting, and, in severe cases, shock. Causes include dehydration, significant blood loss, and autonomic dysfunction.

Venous and Arterial System Examination

The following table summarizes the differences between the Venous System Examination and Arterial System Examination. 

AspectVenous System ExaminationArterial System Examination
PurposeAssess for signs of venous insufficiency, thrombosis, or valve incompetency.Evaluate arterial blood flow, occlusion, or insufficiency.
InspectionLook for varicose veins, stasis dermatitis, and venous ulcers.Observe for pallor, cyanosis, dependent rubor, and arterial ulcers.
PalpationCheck for tenderness (e.g., along superficial veins for thrombophlebitis) and assess for pitting/non-pitting edema.Palpate pulses (e.g., carotid, femoral, dorsalis pedis) and assess for cool skin, delayed capillary refill.
Special TestsTrendelenburg Test: Checks venous valve function. Manual Compression Test: Detects valve incompetence in superficial veins.Ankle-Brachial Index (ABI): Compares ankle and arm blood pressure to assess PAD.
AuscultationNot typically performed unless assessing for venous hums or other vascular anomalies.Listen for bruits over major arteries (e.g., carotid, renal) to detect stenosis or aneurysms.