Badanie fizykalne Układu Sercowo-Naczyniowego | Cardiovascular System Examination

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“Ciężka niewydolność serca”, “Pallor”: “Bladość”, “Reduced cardiac output”: “Obniżona objętość wyrzutowa serca”, “Jugular Venous Distention”: “Poszerzenie żył szyjnych”, “Increased central venous pressure”: “Zwiększone centralne ciśnienie żylne”, “Right-sided heart failure”: “Niewydolność prawej komory serca”, “Fluid overload”: “Przeciążenie płynami”, “Peripheral edema”: “Obrzęk obwodowy”, “edema”: “Obrzęk “, “Venous insufficiency”: “Niewydolność żylna”, “Clubbing”: “Pałeczkowatość palców”, “Chronic hypoxia”: “Przewlekła hipoksja”, “Pulmonary conditions”: “Choroby płuc”, “Precordium”: “Okolica przedsercowa”, “Peripheral pulses”: “Tętno obwodowe”, “Apical Impulse”: “Uderzenie koniuszkowe”, “Point of Maximal Impulse”: “Punkt maksymalnego uderzenia”, “intercostal space”: “przestrzeń międzyżebrowa”, “Midclavicular line”: “Linia środkowo-obojczykowa”, “Left ventricular hypertrophy”: “Przerost lewej komory serca”, “Dilated cardiomyopathy”: “Kardiomiopatia rozstrzeniowa”, “Pericardial effusion”: “Płyn w osierdziu”, “Pulse deficits”: “Deficyt tętna”, “Atrial fibrillation”: “Migotanie przedsionków”, “Pulsus Paradoxus”: “Tętno paradoksalne”, “Cardiac tamponade”: “Tamponada serca”, “Severe asthma”: “Ciężka astma”, “COPD”: “Przewlekła obturacyjna choroba płuc (POChP)”, “Cardiac borders”: “Granice serca”, “Cardiomegaly”: “Powiększenie serca”, “Auscultatory Areas”: “Obszary osłuchiwania”, “Aortic Area”: “Obszar aortalny”, “Pulmonary Area”: “Obszar płucny”, “Tricuspid Area”: “Obszar trójdzielny”, “Mitral Area”: “Obszar mitralny”, “Heart Sounds”: “Tony serca”, “S1”: “Pierwszy ton serca”, “S2”: “Drugi ton serca”, “Physiological splitting”: “Fizjologiczne rozdwojenie”, “Right bundle branch block”: “Blok prawej odnogi pęczka Hisa”, “Atrial septal defect”: “Ubytek przegrody międzyprzedsionkowej”, “Extra Heart Sounds”: “Dodatkowe tony serca”, “S3”: “Trzeci ton serca”, “S4”: “Czwarty ton serca”, “Ventricular gallop”: “Galop komorowy”, “Atrial gallop”: “Galop przedsionkowy”, “Heart murmurs”: “Szmery sercowe”, “Turbulent blood flow”: “Turbulentny przepływ krwi”, “Valve stenosis”: “Zwężenie zastawki”, “Valve regurgitation”: “Niedomykalność zastawki”, “Septal defects”: “Wady przegrody”, “Mitral valve”: “Zastawka mitralna”, “Tricuspid valve”: “Zastawka trójdzielna”, “Aortic valve”: “Zastawka aortalna”, “Pulmonic valve”: “Zastawka płucna”, “Systole”: “Skurcz serca”, “Diastole”: “Rozkurcz serca”, “Volume overload”: “Przeciążenie objętościowe”, “Heart failure”: “Niewydolność serca”, “Hypertrophic cardiomyopathy”: “Kardiomiopatia przerostowa”, “Hypertension”: “Nadciśnienie”, “Systolic murmurs”: “Szmery skurczowe”, “Diastolic murmurs”: “Szmery rozkurczowe”, “Continuous murmurs”: “Szmery ciągłe”, “Aortic stenosis”: “Zwężenie zastawki aortalnej”, “Crescendo-decrescendo murmur”: “Szum crescendo-decrescendo”, “Mitral regurgitation”: “Niedomykalność zastawki mitralnej”, “Holosystolic murmur”: “Szum holosystoliczny”, “Aortic regurgitation”: “Niedomykalność zastawki aortalnej”, “Decrescendo murmur”: “Szum decrescendo”, “Mitral stenosis”: “Zwężenie zastawki mitralnej”, “Low-pitched rumbling murmur”: “Niski, szorstki szmer”, “Patent Ductus Arteriosus”: “Przetrwały przewód tętniczy”, “Machinery-like murmur”: “Szum maszynowy”, “Timing”: “Czas trwania”, “Location”: “Lokalizacja”, “Radiation”: “Promieniowanie”, “Intensity”: “Natężenie”, “Pericardial friction rub”: “Tarcie osierdziowe”, “Pericarditis”: “Zapalenie osierdzia”, “Inflamed pericardial layers”: “Zapalone warstwy osierdzia”, “Cardiac output”: “Rzut serca”, “Radial pulse”: “Tętno promieniowe”, “Systolic blood pressure”: “Ciśnienie tętnicze skurczowe”, “Inspiration”: “Wdech”, “Percussion”: “Opukiwanie”, “Distension”: “Poszerzenie”, “Jugular veins”: “Żyły szyjne”, “Lower extremities”: “Kończyny dolne”, “Murmurs”: “Szmery”, “Pulmonary valve”: “Zastawka płucna”, “Diaphragm and bell of the stethoscope”: “Membrana i lejek stetoskopu”, “Heart valves”: “Zastawki serca”, “Mitral and tricuspid valves”: “Zastawki mitralna i trójdzielna”, “Aortic and pulmonic valves”: “Zastawki aortalna i płucna”, “Bell of stethoscope”: “Lejek stetoskopu”, “Mitral/tricuspid valves”: “Zastawki mitralna/trójdzielna”, “Aortic/pulmonic valves”: “Zastawki aortalna/płucna”, “Intercostal spaces”: “Przestrzenie międzyżebrowe”, “Axilla”: “Pacha”, “Radiates”: “Promieniuje”, “Ventricular filling”: “Napełnianie komór”, “Rumbling murmur”: “Niski, szorstki szmer”, “Left lateral decubitus position”: “Pozycja lewoboczna na boku”, “Apex of the heart”: “Wierzchołek serca”, “Patient leaning forward”: “Pacjent pochylony do przodu”, “Diminishes”: “Zmniejsza się”, “Low-pitched”: “Niskotonowy”, “Murmur”: “Szmer”, “Systolic”: “Skurczowy”, “Diastolic”: “Rozkurczowy”, “Continuous”: “Ciągły”, “Radiate”: “Promieniować” }; // Normalize keys in the dictionary const normalizedWordsToTooltip = {}; for (const [key, value] of Object.entries(wordsToTooltip)) { const cleanedKey = key.replace(/(.*?)/g, ”).trim(); // Remove anything in parentheses 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Szacowany czas lekcji: 16 minut
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General Inspection

During the initial inspection, look for signs that may suggest cardiovascular disease.

  • Cyanosis: Bluish discoloration of the lips or extremities suggests hypoxemia, which may occur with congenital heart defects or severe heart failure.
  • Pallor: Pale skin may indicate anemia or reduced cardiac output.
  • Jugular Venous Distention (JVD): Visible distension of the jugular veins is a sign of increased central venous pressure, typically seen in right-sided heart failure or fluid overload.
  • Edema: Peripheral edema, particularly in the lower extremities, suggests right-sided heart failure or venous insufficiency.
  • Clubbing: Enlargement of the distal fingers, known as clubbing, may indicate chronic hypoxia associated with congenital heart disease or pulmonary conditions.

Palpation

Palpation of the precordium and peripheral pulses helps assess cardiac function and peripheral circulation.

Apical Impulse (Point of Maximal Impulse – PMI)

The PMI is normally located at the 5th intercostal space at the midclavicular line.

  • Displacement: A laterally displaced PMI suggests left ventricular hypertrophy or dilation, often due to hypertension or heart failure.
  • Size and quality: A sustained and forceful PMI suggests left ventricular hypertrophy, while a weak PMI may indicate dilated cardiomyopathy or pericardial effusion.

Peripheral Pulses

Assessing the rate, rhythm, and amplitude of peripheral pulses helps in identifying abnormalities in circulation and cardiac output.

  • Pulse Deficits: A pulse deficit occurs when the heartbeats do not match the radial pulse, suggesting arrhythmias like atrial fibrillation.
  • Pulsus Paradoxus: A marked decrease in systolic blood pressure during inspiration is a classic sign of cardiac tamponade or severe asthma/COPD.

Percussion 

Percussion is less commonly used in modern cardiovascular exams due to the availability of imaging modalities but can still be useful in estimating heart size.

  • Cardiac borders: Percussion of the chest helps define the boundaries of the heart. A shift in the cardiac borders may indicate cardiomegaly or other structural abnormalities such as pericardial effusion.

Auscultation

Auscultation is one of the most critical components of the cardiovascular examination. It provides valuable insights into the mechanical and electrical activity of the heart, allowing clinicians to detect normal and abnormal heart sounds, murmurs, and other findings that may indicate underlying pathology.

Auscultatory Areas

Auscultation should be performed in specific areas of the chest that correspond to the locations where heart sounds and murmurs are most prominent. 

Auscultatory AreaLocationValve Assessed
Aortic AreaRight second intercostal spaceAortic valve
Pulmonary AreaLeft second intercostal spacePulmonary valve
Tricuspid AreaLeft lower sternal borderTricuspid valve
Mitral AreaFifth intercostal space, midclavicular lineMitral valve

Note: Proper auscultation involves listening with both the diaphragm and bell of the stethoscope. The diaphragm is used to hear higher-pitched sounds such as S1 and S2, while the bell is more effective for detecting lower-pitched sounds like S3, S4, and murmurs associated with mitral stenosis.

Heart Sounds

The heart produces two primary sounds during a normal cardiac cycle. During auscultation the first (S1) and second (S2) heart sounds are the primary sounds heard. These correspond to the closure of the heart valves during the cardiac cycle:

  • S1 is caused by the closure of the mitral and tricuspid valves at the onset of systole, best heard at the apex of the heart.
  • S2 corresponds to the closure of the aortic and pulmonic valves at the end of systole and is best heard at the base of the heart, near the second intercostal spaces.

Note: During inspiration, there may be physiological splitting of S2 due to delayed closure of the pulmonic valve. However, a wide or fixed splitting of S2 can be pathological and may indicate conditions such as right bundle branch block or atrial septal defect.

Extra Heart Sounds (S3 and S4)

Additional heart sounds may also be heard under certain pathological conditions:

  • S3 (ventricular gallop) occurs after S2 and suggests volume overload, as seen in heart failure. It is a low-pitched sound, best heard with the bell of the stethoscope at the apex.
  • S4 (atrial gallop) occurs just before S1 and is associated with a stiff or hypertrophied ventricle, commonly seen in hypertrophic cardiomyopathy or chronic hypertension. Like S3, it is best heard at the apex with the bell of the stethoscope.
Heart SoundTimingAssociated ConditionBest Heard
S1Beginning of systoleNormal closure of mitral/tricuspid valvesApex of the heart
S2End of systoleNormal closure of aortic/pulmonic valvesBase of the heart (2nd intercostal spaces)
S3Early diastoleHeart failure, volume overloadApex with bell of stethoscope
S4Late diastoleHypertrophic cardiomyopathy, hypertensionApex with bell of stethoscope

Murmurs

Heart murmurs are caused by turbulent blood flow through the heart, often due to structural abnormalities such as valve stenosis, regurgitation, or septal defects. They are classified based on their timing within the cardiac cycle:

Systolic Murmurs

Systolic murmurs occur between the first heart sound (S1) and the second heart sound (S2), during ventricular contraction. Common conditions include:

ConditionDescriptionLocation Heard BestRadiation
Aortic StenosisCrescendo-decrescendo murmur (increases then decreases in intensity)Right second intercostal spaceRadiates to the neck
Mitral RegurgitationHolosystolic (constant intensity throughout systole) murmurApex of the heartRadiates to the axilla

Diastolic Murmurs

Diastolic murmurs occur between the second heart sound (S2) and the first heart sound (S1) of the next cycle, during ventricular filling. Common conditions include:

ConditionDescriptionLocation Heard BestPosition for Optimal Hearing
Aortic RegurgitationDecrescendo murmur (starts loud, then diminishes)Left sternal borderPatient leaning forward
Mitral StenosisLow-pitched, rumbling murmurApex of the heartLeft lateral decubitus position

Continuous Murmurs

Continuous murmurs occur throughout the cardiac cycle, both during systole and diastole, indicating abnormal blood flow that persists continuously. A common condition associated with a continuous murmur is:

ConditionDescriptionLocation Heard Best
Patent Ductus ArteriosusA continuous “machinery-like” murmur heard throughout systole and diastoleLeft upper sternal border

Key Characteristics of Murmurs

  • Timing: Is the murmur systolic, diastolic, or continuous?
  • Location: Where is the murmur heard best (e.g., aortic area, mitral area)?
  • Radiation: Does the murmur radiate to other regions (e.g., neck, axilla)?
  • Intensity: Graded on a scale of 1 to 6, with 1 being barely audible and 6 being heard with the stethoscope lifted off the chest.

Pericardial Rubs

A pericardial friction rub is a scratching or grating sound caused by inflamed pericardial layers rubbing against each other. It is often heard in patients with pericarditis.