Name: cardiac exam i: checking the chest first
Uploaded: 2023-04-30T06:37:11.000Z
Duration: 7 min 39 s
Channel: JoVE

K12 Standards

Florida Department of Education

High School

Life Science

SC.912.L.14

SC.912.L.14.38

Cardiac Exam I: Inspection and Palpation

1. Introduction
<ol>
	<li>As always, before examining any patient, wash hands thoroughly with soap and water or clean them with antibacterial wash.</li>
	<li>Enter the examination room and introduce yourself to the patient, explaining that you are going to perform a cardiac examination.</li>
</ol>
2. Positioning
<ol>
	<li>Have the patient undress down to the waist (females keeping on their underwear).</li>
	<li>Position the patient on the examination table at a 30- to 45-degree angle, and approach the patient from the right side.</li>
	<li>Have a general look at the patient first. Note whether the patient is comfortable or in any distress.</li>
</ol>
3. Peripheral examination
<ol>
	<li>Ask the patient to hold his/her hands up and assess for the following:
	<ol>
		<li>Capillary refill: Press on the patient&#39;s thumbnail with your first finger while holding the other side of the patient&#39;s finger with your thumb. The skin under the nail will blanch (turn a white color). Measure the amount of time it takes to turn back to red. This should be less than 2 sec, which indicates good peripheral circulation.</li>
		<li>Clubbing, which is defined as a decrease in angle between the nail and nail bed. Clubbing can be a sign of right-to-left shunt disease or bacterial endocarditis (infection of the heart valves): Ask the patient to put both thumbnails side-by-side. Note if a diamond-shape is formed on the inside. If clubbing is present, this doesn&#39;t happen.</li>
		<li>Signs of bacterial endocarditis: splinter hemorrhages (tiny red hemorrhages under the nails), Osler&#39;s nodes (painful red papules often found on the ends of the fingers), Janeway lesions (painless red macules often found on the palms).</li>
	</ol>
	</li>
	<li>Palpate the radial pulse with the index and middle finger, and assess for the rate per minute, rhythm regularity, volume, and character. Low volume or faint pulses are a sign of a low flow state such as sepsis. An abnormally strong &#34;bounding&#34; pulse can be found in conditions such as anemia and congestive heart failure.</li>
	<li>Examine the skin on the arms for xanthoma deposits, which may be observed near the elbows and can be a sign of hyperlipidemia.</li>
	<li>Inspect the patient&#39;s head for any signs of cardiac disease:
	<ol>
		<li>de Musset&#39;s sign: a &#34;bobbing&#34; head movement associated with aortic regurgitation.</li>
		<li>Malar flush: a flushing or red facial appearance indicative of mitral stenosis.</li>
		<li>Inspect the cornea for corneal arcus, a gray-white discoloration around the cornea that is a sign of hyperlipidemia.</li>
		<li>Inspect the skin around the eyes for yellow cholesterol deposits known as xanthelasma.</li>
		<li>Inspect the fundus for retinopathy (which often occurs with cardiovascular disease and diabetes) and Roth&#39;s spots (pale-centered retinal hemorrhages that occur with bacterial endocarditis).</li>
		<li>Ask the patient to open mouth and stick out tongue. The color of the tongue should be pink/red. If it is a bluish discoloration, this is a sign of central cyanosis.</li>
	</ol>
	</li>
	<li>Palpate the carotid pulse gently with your first two fingers, and assess the volume and character of the pulse. A slow rising pulse is a sign of aortic stenosis.</li>
	<li>The jugular venous pressure (JVP) is nature&#39;s manometer of right atrial pressure and is elevated in congestive heart failure.
	<ol>
		<li>To measure the JVP, ask the patient to turn the head to the left while the patient is positioned at 45 degrees.</li>
		<li>Observe for a double pulsation from the right internal jugular vein between the two heads of sternocleidomastoid (the sternal head and the clavicular head). The carotid pulse that sometimes can be seen in thin patients has a single pulsation and is palpable, while the jugular vein pulsation is not.</li>
		<li>Locate the angle of Louis (manubriosternal joint), which is positioned about 5 cm above the center of the right atrium.</li>
		<li>Extend a long rectangular object (such as a paper card) horizontally from the highest point at which the internal jugular vein pulsation can be seen.</li>
		<li>Using a vertically positioned ruler measure the distance from the angle of Louis to the card and calculate the JVP by adding 5 cm (the distance from the angle of Louis to the right atrium) to that number.</li>
		<li>Another way to visualize the internal jugular vein is to press gently in the right upper quadrant of the abdomen, just below the costal margin. This maneuver induces so-called hepatojugular reflux (blood shift from abdominal vessels into the right atrium). Normally, a transient increase in JVP can be observed before a decrease. Sustained increase in JVP is seen in congestive heart failure and other conditions, such as tricuspid regurgitation and constrictive pericarditis.</li>
	</ol>
	</li>
</ol>
4. Chest inspection
<ol>
	<li>Inspect the patient&#39;s chest anteriorly and posteriorly for any visible scars. Look for any evidence of a median sternotomy scar (a sign of coronary artery bypass surgery or aortic valve surgery). A more lateral scar below the left nipple would be indicative of prior mitral valve surgery.</li>
</ol>
5. Palpation
<ol>
	<li>The apex beat, also known as the point of maximal impulse (PMI), corresponds to the lower left heart border. It is the most inferior and lateral position that the cardiac impulse can be felt.
	<ol>
		<li>Locate the PMI in the fifth intercostal space in the mid-clavicular line by counting down from the second intercostal space adjacent to the angle of Louis.</li>
		<li>Palpate with your first two fingers.</li>
		<li>If this cannot be palpated, ask the patient to lie on his/her left side. The apex beat will be displaced laterally if the heart is enlarged (cardiomegaly).</li>
	</ol>
	</li>
	<li>Next, palpate for heaves and thrills (a thrill is a palpable murmur).
	<ol>
		<li>Place the palm of your hand in each of the four heart zones in the precordium and then on the upper left and right chest wall. A thrill feels like a vibration or buzzing underneath your hand.</li>
		<li>Place your hand at the left sternal edge. A parasternal heave is a sign of right ventricular enlargement and feels like a &#34;lifting feeling&#34; under your hand.</li>
	</ol>
	</li>
</ol>
6. Percussion of heart
<ol>
	<li>Unlike many other examinations, percussion is rarely employed for the cardiac system; however, a few generations ago, physicians would use percussion of the borders of the heart to assess for cardiomegaly.</li>
</ol>
7. Other inspection and palpation
<ol>
	<li>Palpate for an abdominal aneurysm in the midline of the abdomen using both hands placed parallel with each other.</li>
	<li>Look at the legs and assess for any signs of edema.</li>
	<li>Feel the peripheral pulses at the femoral, popliteal, anterior tibial, and dorsalis pedis locations.</li>
</ol>
<div class="chapter_text" id="script_0">
	The cardiac assessment is one of the core physical examinations performed by every physician whenever they encounter a patient. Proper functioning of the cardiac system is vital for living, and disorders associated with it are among the most common reasons for hospital admissions across the globe. Therefore, learning how to perform a complete and thorough cardiac examination is crucial for any practicing clinician.
	Many physicians instinctively reach straight for their stethoscope when performing a cardiac exam. However, a lot of information can be gained before auscultation by conducting thorough inspection and palpation. This video will review these two aspects of the cardiac exam in detail. 
</div>
<div class="chapter_text" id="script_1">
	Let's go over the sequence of inspection and palpation steps for the cardiac system evaluation along with the expected findings. Before the exam, wash your hands thoroughly. Upon entering the room, introduce yourself to the patient and briefly explain the procedure you will perform. Have the patient undress down to their waist. Instruct them to lie down on the exam table positioned at a 30-45&deg; angle, and approach the patient from their right side. 
	Start by inspecting the periphery. Ask the patient to hold one hand up, press on the thumbnail and watch the nail bed blanch. Then, release the pressure and estimate the time it takes to turn back to red. This is the capillary refill time, which serves as an indicator of peripheral circulation. Following the capillary refill test, instruct the patient to put their thumbnails side by side to check for nail clubbing. Note that a diamond-shape aperture is formed, which means clubbing is absent. If no aperture is formed, then it may suggest presence of chronic hypoxia conditions such as right-to-left shunt disease or bacterial endocarditis. To examine for other signs of bacterial endocarditis, inspect for red hemorrhages under the nails, referred to as the splinter hemorrhages. Then, look for the Osler's nodes, which are painful red papules on the finger ends. Also check if you can see the Janeway lesions, which are painless red macules on the palms. Moving to the wrist, palpate the radial pulse with the index and middle finger, and evaluate the pulse rate, rhythm regularity, pulse volume, and character. Next, inspect the skin on the arms, especially near the elbows, and look for yellowish deposits known as the xanthoma deposits, which is a sign of hyperlipidemia. 
	After examining the periphery, inspect the patient's head for the de Musset's sign, which is represented by rhythmic head nodding in synchrony with the heartbeats. This is associated with aortic regurgitation. Check the patient's face for Malar flush, which is a red facial appearance indicative of mitral stenosis. Next, inspect the skin around the eyes for yellow cholesterol deposits known as xanthelasma. Then examine the corneas for corneal arcus-a gray-white discoloration indicative of hyperlipidemia. To finish the facial inspection, ask the patient to open their mouth and stick out their tongue. Note the color to check for cyanosis. 
	Proceed to the neck region. First palpate the carotid arteries, which are right next to the trachea and can be felt about 2 cm below the angle of the mandible. Gently press at this spot with your first two fingers, and assess the pulse volume and character. Subsequently, measure the jugular venous pressure or JVP. To do that, you'll need to locate the right internal jugular vein and the Angle of Louis, which is the anterior angle formed at the manubriosternal joint. The internal jugular veins run between the two heads-sternal and clavicular- of the sternocleidomastoid muscle, which form a triangle with the clavicle at the bottom edge. In order to locate this vein, ask the patient to turn their head to the left. Observe for a double pulsation, which is produced by the right internal jugular vein. Next, locate the Angle of Louis by palpation, which is approximately 5 cm above the center of the right atrium and next to the second intercostal space. After locating the angle of Louis, extend a long rectangular object, such as a paper card, horizontally from the highest point at which the internal jugular vein pulsation can be seen, and then using a ruler measure the distance in cm from the angle of Louis to the paper card. The measured distance plus 5 equals JVP, which is normally 6 to 8.
	Following JVP measurement, inspect the patient's chest anteriorly and posteriorly for any visible scars indicative of prior heart surgeries. Next step is to locate the point of maximal impulse or PMI. Using the Angle of Louis as the reference point, count down to the 5th intercostal space to palpate the PMI in the mid-clavicular line. If this cannot be palpated in seated position, request the patient to lie on their left side and then palpate. Note that the apex beat will be displaced laterally in cases of cardiomegaly. Next, use your palm to palpate the four heart zones in the precordium, and the upper left and right chest wall. Note any vibrations or buzzing underneath your hand, which could indicate thrills. To complete chest palpation, place your hand at the left sternal edge. If you experience a "lifting feeling" under your hand, it indicates a parasternal heave, which is a sign of right ventricular enlargement. 
	Moving down from the chest, palpate the abdomen for an aneurysm in the midline using both hands placed parallel with each other. Next, inspect and palpate the legs for any signs of edema. Finally, feel the peripheral pulses at the femoral, popliteal, posterior tibial, and dorsalis pedis locations. This concludes the inspection and palpation aspect of the cardiac exam.
</div>
<div class="chapter_text" id="script_2">
	You've just watched JoVE's video on inspection and palpation of the cardiac system. A significant amount of clinical information can be gained if a clinician performs all these steps in a careful, precise and thorough manner. By learning the full examination technique, a medical professional gains a solid foundation for building clinical skills in order to predict cardiac pathology in advance. As always, thanks for watching!
</div>

A significant amount of clinical information is to be gained with a thorough comprehensive inspection and palpation of the cardiac system. The examiner should be able to tell whether a patient has a number of likely conditions, including atrial fibrillation, valvular heart disease, cardiomegaly, hyperlipidemia, and bacterial endocarditis. Unfortunately, during everyday clinical practice, these steps are often abbreviated or skipped. By learning the full examination technique, medical professionals gain a solid foundation on which to build their clinical skills, as they see more cardiac pathology. Going through a stepwise fashion of the cardiovascular system can lead physicians to diagnoses even before placing their stethoscopes on patients.

cardiac exam i: inspection and palpation

Source: <a href="https://www.jove.com/author/Suneel_Dhand">Suneel Dhand</a>, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center
The cardiac assessment is one of the core examinations performed by almost every physician whenever encountering a patient. Disorders of the cardiac system are among the most common reasons for hospital admission, with conditions ranging from myocardial infarction to congestive heart failure. Learning a complete and thorough cardiac examination is therefore crucial for any practicing physician.
If there is pathology in the heart or circulatory system, the consequences can also be manifested in other bodily areas, including the lungs, abdomen, and legs. Many physicians instinctively reach straight for their stethoscopes when performing cardiac exams. However, a large amount of information is gained before auscultation by going through the correct sequence of examination, starting with inspection and palpation.

Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center
The cardiac assessment is one of the core ...

The cardiac assessment is one of the core physical examinations performed by every physician whenever they encounter a patient. Proper functioning of the cardiac system is vital for living, and disorders associated with it are among the most common reasons for hospital admissions across the globe. Therefore, learning how to perform a complete and thorough cardiac examination is crucial for any practicing clinician.Many physicians instinctively reach straight for their stethoscope when performing a cardiac exam. However, a lot of information can be gained before auscultation by conducting thorough inspection and palpation. This video will review these two aspects of the cardiac exam in detail. Let's go over the sequence of inspection and palpation steps for the cardiac system evaluation along with the expected findings. Before the exam, wash your hands thoroughly. Upon entering the room, introduce yourself to the patient and briefly explain the procedure you will perform. Have the patient undress down to their waist. Instruct them to lie down on the exam table positioned at a 30-45? angle, and approach the patient from their right side. Start by inspecting the periphery. Ask the patient to hold one hand up, press on the thumbnail and watch the nail bed blanch. Then, release the pressure and estimate the time it takes to turn back to red. This is the capillary refill time, which serves as an indicator of peripheral circulation. Following the capillary refill test, instruct the patient to put their thumbnails side by side to check for nail clubbing. Note that a diamond-shape aperture is formed, which means clubbing is absent. If no aperture is formed, then it may suggest presence of chronic hypoxia conditions such as right-to-left shunt disease or bacterial endocarditis. To examine for other signs of bacterial endocarditis, inspect for red hemorrhages under the nails, referred to as the splinter hemorrhages. Then, look for the Osler's nodes, which are painful red papules on the finger ends. Also check if you can see the Janeway lesions, which are painless red macules on the palms. Moving to the wrist, palpate the radial pulse with the index and middle finger, and evaluate the pulse rate, rhythm regularity, pulse volume, and character. Next, inspect the skin on the arms, especially near the elbows, and look for yellowish deposits known as the xanthoma deposits, which is a sign of hyperlipidemia. After examining the periphery, inspect the patient's head for the de Musset's sign, which is represented by rhythmic head nodding in synchrony with the heartbeats. This is associated with aortic regurgitation. Check the patient's face for Malar flush, which is a red facial appearance indicative of mitral stenosis. Next, inspect the skin around the eyes for yellow cholesterol deposits known as xanthelasma. Then examine the corneas for corneal arcus-a gray-white discoloration indicative of hyperlipidemia. To finish the facial inspection, ask the patient to open their mouth and stick out their tongue. Note the color to check for cyanosis. Proceed to the neck region. First palpate the carotid arteries, which are right next to the trachea and can be felt about 2 cm below the angle of the mandible. Gently press at this spot with your first two fingers, and assess the pulse volume and character. Subsequently, measure the jugular venous pressure or JVP. To do that, you'll need to locate the right internal jugular vein and the Angle of Louis, which is the anterior angle formed at the manubriosternal joint. The internal jugular veins run between the two heads-sternal and clavicular- of the sternocleidomastoid muscle, which form a triangle with the clavicle at the bottom edge. In order to locate this vein, ask the patient to turn their head to the left. Observe for a double pulsation, which is produced by the right internal jugular vein. Next, locate the Angle of Louis by palpation, which is approximately 5 cm above the center of the right atrium and next to the second intercostal space. After locating the angle of Louis, extend a long rectangular object, such as a paper card, horizontally from the highest point at which the internal jugular vein pulsation can be seen, and then using a ruler measure the distance in cm from the angle of Louis to the paper card. The measured distance plus 5 equals JVP, which is normally 6 to 8.Following JVP measurement, inspect the patient's chest anteriorly and posteriorly for any visible scars indicative of prior heart surgeries. Next step is to locate the point of maximal impulse or PMI. Using the Angle of Louis as the reference point, count down to the 5th intercostal space to palpate the PMI in the mid-clavicular line. If this cannot be palpated in seated position, request the patient to lie on their left side and then palpate. Note that the apex beat will be displaced laterally in cases of cardiomegaly. Next, use your palm to palpate the four heart zones in the precordium, and the upper left and right chest wall. Note any vibrations or buzzing underneath your hand, which could indicate thrills. To complete chest palpation, place your hand at the left sternal edge. If you experience a "lifting feeling" under your hand, it indicates a parasternal heave, which is a sign of right ventricular enlargement. Moving down from the chest, palpate the abdomen for an aneurysm in the midline using both hands placed parallel with each other. Next, inspect and palpate the legs for any signs of edema. Finally, feel the peripheral pulses at the femoral, popliteal, posterior tibial, and dorsalis pedis locations. This concludes the inspection and palpation aspect of the cardiac exam.You've just watched JoVE's video on inspection and palpation of the cardiac system. A significant amount of clinical information can be gained if a clinician performs all these steps in a careful, precise and thorough manner. By learning the full examination technique, a medical professional gains a solid foundation for building clinical skills in order to predict cardiac pathology in advance. As always, thanks for watching!

Education

JoVE Science Education

Clinical Skills

Physical Examinations I

cardiac exam i: checking the chest first

Cardiac exam inspection and palpation are the first steps in a careful heart assessment. These steps help a physician gather useful information before using a stethoscope. They are part of the core examination performed when a patient is first seen.

Heart and circulatory disorders are common reasons for hospital admission. They can include conditions such as myocardial infarction and congestive heart failure. Because of this, learning a complete cardiac examination is important for any practicing physician.

A heart problem may also show signs in other parts of the body. Changes can appear in the lungs, abdomen, and legs. That is why the exam starts with looking and feeling, not with listening right away.

Cardiac Exam I: Checking the Chest First

general approach to the physical exam

Why Physical Exams Still Matter

Physical examination remains an important part of medicine. Doctors have used the body exam for centuries to connect changes in body function with disease. Even with modern imaging and lab tests, the bedside exam still helps clinicians understand what may be happening in the patient. Physical examination is not a replacement for tests, and it does not answer every question. Some maneuvers that were once highly valued may have limited usefulness. Still, many conditions can only be found through...

observation and inspection

Clinical Observation in Physical Exam

Clinical observation is the starting point of a physical examination and begins at the first contact with a patient. Observation is a broad term for using the senses carefully to gather information. Inspection is a narrower term. It refers to what can be seen with the eyes, especially on the surface of the body, rather than to behavior. Skilled clinicians use more than sight when they examine a patient. They also rely on touch, through palpation and percussion, and on hearing, through...

palpation

How Hand Position Guides Palpation

Palpation uses touch to collect diagnostic information during the physical exam. It is one of the ways a healthcare provider uses the senses to learn more about a patient. The part of the hand used for palpation changes depending on the body area being examined. Finger pads are best for fine detail. Their dense sensory nerves help the examiner feel small features, such as the borders of masses or lymph nodes. The back of the hand, also called the dorsal surface, gives a rough sense of relative...

percussion

Clinical Percussion and Body Sound

Clinical percussion uses tapping to create sound and help assess what lies beneath the body surface. It is a simple bedside technique that depends on the way sound changes when it travels through different tissues. The method began with Leopold Auenbrugger, an Austrian inn-keeper's son, who found that tapping beer barrels could help him take inventory. He later applied the same idea to patients in Vienna and published the first description of its diagnostic use in 1761. Jean-Nicolas Corvisart...

auscultation

Stethoscope Sounds in Clinical Exam

Auscultation is a clinical exam method that lets a provider listen to sounds inside the body. Doctors use it to gather important diagnostic information from the chest, heart, abdomen, and blood vessels. For many years, auscultation meant immediate auscultation. In that method, the examiner placed an ear directly on the patient's skin. This approach was used for centuries, but it became less useful in nineteenth-century France because of social norms and poor diagnostic yield. René Laënnec...

proper adjustment of patient attire during the physical exam

proper-adjustment-of-patient-attire-during-the-physical-exam

Draping for a Better Physical Exam

Draping is an important part of a careful physical exam. It helps the provider examine the right body area while also protecting patient modesty. Good draping takes practice because the examiner must balance exposure with comfort. Correct technique also improves the accuracy of the exam. Skin lesions can be missed if inspection is done through clothing. Lung crackles may be reported by mistake when the chest is examined through a T-shirt, and subtle heart findings can be missed when...

blood pressure measurement

Manual Blood Pressure Reading Steps

Blood pressure reading uses an indirect method to measure the pressure of blood against vessel walls. Blood pressure, or BP, is a vital sign that is checked routinely in hospital and outpatient settings. It is one of the most common medical assessments performed around the world. The indirect method is non-invasive, safe, and easily reproducible, so it is used most often. BP can be measured automatically by oscillometry or manually by auscultation. Auscultation uses a sphygmomanometer, which...

measuring vital signs

Vital Sign Ranges and Patient Status

Vital signs are objective measurements that show a patient’s clinical status. The commonly accepted vital signs are blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation. In many practices, pain is also treated as the sixth vital sign and is documented with the others. Pain is different from the other vital signs because it is a subjective measurement. That means the pain scale can vary from one patient to another. A vital signs assessment includes heart rate, blood...

respiratory exam i: inspection and palpation

respiratory-exam-i-inspection-and-palpation

Checking Breathing Distress by Exam

Respiratory exam starts with looking for breathing distress and feeling the chest. Shortness of breath is a common reason for both outpatient and inpatient evaluation. Early inspection can reveal fast breathing or cyanosis, which is a bluish color change that can signal low oxygen. If a patient shows respiratory distress, the situation needs urgent attention and oxygen therapy. In many cases, careful clinical examination can help identify lung problems without relying only on tests. This is...

respiratory exam ii: percussion and auscultation

respiratory-exam-ii-percussion-and-auscultation

Respiratory Exam: Lung Sounds and Percussion

Respiratory exam skills include percussion and auscultation of the lungs. These techniques help identify lung problems during a physical exam. Percussion uses tapping to assess the chest, and auscultation uses a stethoscope to listen for breath sounds. Percussion is a useful skill that is often skipped in routine clinical practice. When it is done correctly, it can help a physician detect underlying lung pathology. Auscultation can also give an almost immediate clue to several acute pulmonary...

Cardiac exam inspection and palpation are the first steps in a careful heart assessment. These steps help a physician gather useful information before using a stethoscope. They are part of the core examination performed when a patient is first seen. Heart and circulatory disorders are common reasons for hospital admission. They can include conditions such as myocardial infarction and congestive heart failure. Because of this, learning a complete cardiac examination is important for any...

cardiac exam ii: auscultation

Listening for Normal and Abnormal Heart Sounds

Heart auscultation uses a stethoscope to listen to heart sounds and check for normal and abnormal patterns. For physicians, knowing how to hear these sounds and tell them apart is an essential skill. The sound heard at each spot on the chest relates to the closing of specific heart valves. The heart has two main sounds, called S1 and S2. S1 happens when the mitral and tricuspid valves, which are the atrioventricular valves, close after blood enters the ventricles. This marks the start of...

cardiac exam iii: abnormal heart sounds

Heart Murmurs and Gallop Sounds

Heart murmurs and gallop sounds are abnormal heart sounds that can be heard during auscultation, or listening to the heart with a stethoscope. A good understanding of normal heart sounds is the first step in telling normal sounds apart from abnormal ones. Murmurs usually have a swishing quality and point to turbulent blood flow across a heart valve. Murmurs can happen because a valve is too narrow, which is called stenosis, or because blood leaks backward across the valve, which is called...

peripheral vascular exam

Assessing PAD and Venous Signs

Peripheral vascular disease can affect blood flow in the arms and legs, and careful exam steps help reveal signs of disease. Peripheral artery disease (PAD) is linked to cardiovascular and cerebrovascular complications. Risk factors include diabetes, hyperlipidemia, hypertension, and tobacco use. Symptoms may appear as limb claudication, which is cramp-like muscle pain that gets worse with activity and better with rest. Chronic venous insufficiency (CVI) can cause lower extremity swelling,...

peripheral vascular exam using a continuous wave doppler

peripheral-vascular-exam-using-a-continuous-wave-doppler

Bedside Doppler for Leg Blood Flow Checks

Peripheral vascular disease affects the arteries and veins outside the heart, and it is common in older adults. History and physical exam can suggest the diagnosis, but Doppler ultrasound is now a routine part of the bedside vascular exam. This lesson focuses on bedside assessment of peripheral arterial disease and chronic venous insufficiency with a handheld continuous wave Doppler. A handheld Doppler is a simple tool that sends and receives ultrasound at the same time. It detects changes in...

physical examinations i

This collection provides a foundation for performing physical exams; with techniques ranging from measuring blood pressure or vital signs, to key pulmonary and cardiovascular physical examinations. 

Learn why inspection and palpation come first in a cardiac exam, and how these early steps can reveal signs of heart and circulatory problems.

Cardiac Exam I: Checking the Chest First | JoVE K12

new-york-state-science-learning-standards

New York State Science Learning Standards

Structure and Function

HS-LS1-3.

Suneel Dhand

Beth Israel Deaconess Medical Center

Overview

Steps for Cardiac Inspection and Palpation

Summary

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Fluid Mosaic Model

The fluid mosaic model was first proposed as a visual representation of research observations. The model comprises the composition and dynamics of ...

What is an Electrochemical Gradient?

Adenosine triphosphate, or ATP, is considered the primary energy source in cells. However, energy can also be stored in the electrochemical gradient of an ...

Diffusion

Diffusion is the passive movement of substances down their concentration gradients&#x2014;requiring no expenditure of cellular energy. Substances, such as ...

Osmosis

Approximately 60% to 95% of the weight of living organisms is attributed to water. Therefore, maintaining appropriate water balance within cells is of ...

Tonicity in Animals

The tonicity of a solution determines if a cell gains or loses water in that solution. The tonicity depends on the permeability of the cell membrane for ...

Tonicity in Plants

Tonicity describes the capacity of a cell to lose or gain water. It depends on the quantity of solute that does not penetrate the membrane. Tonicity ...

Introduction to Membrane Proteins

The cell membrane, or plasma membrane, is an ever-changing landscape. It is described as a fluid mosaic where various macromolecules are embedded in the ...

Facilitated Transport

The chemical and physical properties of plasma membranes cause them to be selectively permeable. Since plasma membranes have both hydrophobic and ...

Primary Active Transport

In contrast to passive transport, active transport involves a substance being moved through membranes in a direction against its concentration or ...

Secondary Active Transport

One example of how cells use the energy contained in electrochemical gradients is demonstrated by glucose transport into cells. The ion vital to this ...

Receptor-mediated Endocytosis

Overview

Receptor-mediated endocytosis is a process through which bulk amounts of specific molecules can be imported into a cell after binding to cell ...

Pinocytosis

Cells use energy-requiring bulk transport mechanisms to transfer large particles, or large amounts of small particles, into or out of the cell. The cells ...

Phagocytosis

Cells pull particles inward and engulf them in spherical vesicles in an energy-requiring process called endocytosis. Phagocytosis (&#x201C;cellular ...

Exocytosis

Exocytosis is used to release material from cells. Like other bulk transport mechanisms, exocytosis requires energy.

While endocytosis takes particles ...

Relate structure to function for the components of plant and animal cells. Explain the role of cell membranes as a highly selective barrier (passive and active transport).

SC.912.L.14.2

Cell Structure

Background
Cells represent the most basic biological units of all organisms, whether it be simple, single-celled organisms like bacteria, or large, ...

Compare and contrast the general structures of plant and animal cells. Compare and contrast the general structures of prokaryotic and eukaryotic cells.

SC.912.L.14.3

Overview of Microscopy Techniques

The early pioneers of microscopy opened a window into the invisible world of microorganisms. In 1830, Joseph Jackson Lister created an essentially modern ...

Introduction to Light Microscopy

The light microscope is an instrument used by researchers in many different fields to magnify specimens to as much as a thousand times their original ...

Overview of Electron Microscopy

The wavelengths of visible light ultimately limit the maximum theoretical resolution of images created by light microscopes. Most light microscopes can ...

phase-contrast-and-differential-interference-contrast-microscopy

Phase Contrast and Differential Interference Contrast Microscopy

Phase-Contrast Microscopes
In-phase-contrast microscopes, interference between light directly passing through a cell and light refracted by cellular ...

Confocal Fluorescence Microscopy

Confocal microscopy is an advanced microscopic technique. The prime advantage of the confocal microscope over other microscopy techniques is its ability ...

Introduction to Fluorescence Microscopy

Fluorescence microscopy is a very powerful analytical tool that combines the magnifying properties of light microscopy with visualization of fluorescence. ...

Super-resolution Fluorescence Microscopy

Super-resolution fluorescence microscopy (SRFM) provides a better resolution than conventional fluorescence microscopy by reducing the point spread ...

Compare and contrast structure and function of various types of microscopes.

SC.912.L.14.4

comparing-mitochondrial-chloroplast-and-prokaryotic-genomes

Comparing Mitochondrial, Chloroplast, and Prokaryotic Genomes

The present-day mitochondrial and chloroplast genomes have retained some of the characteristics of their ancestral prokaryotes and also have acquired new ...

the-tree-of-life-bacteria-archaea-eukaryotes

The Tree of Life - Bacteria, Archaea, Eukaryotes

The &#8220;tree of life&#8221; describes the evolution of life and the evolutionary relationships between organisms. The root of the tree is the common ...

The Anatomy of Chloroplasts

Green algae and plants, including green stems and unripe fruit, harbor specialized organelles called chloroplasts to carry out photosynthesis. They ...

Explain the evidence supporting the scientific theory of the origin of eukaryotic cells (endosymbiosis).

SC.912.L.14.5

An Overview of Genetics and Disease

Many human diseases are associated with mutations or variations in genetic sequences. Some of these genetic variants are heritable, passed down from ...

Factors Affecting Illness

When a person&#39;s physical, emotional, intellectual, social development or spiritual functioning is compromised, this deviation from a healthy normal ...

Gene-Environment Interactions

Gene expression is influenced by environmental factors such as radiation, temperature, behavior, nutrition, and stress.
The range of reaction suggests ...

Dimensions of Health and Illness

The factors influencing the health-illness continuum can be internal or external and may or may not be under conscious control. They are related to the ...

Factors Affecting the Risk of Infection

The hosts&#39; susceptibility to infection depends on several factors. The integrity of the skin and mucous membranes helps protect the body against ...

An Overview of Genetic Analysis

An organism&#8217;s physical traits, or phenotype, are a product of its genotype, which is the combination of alleles (gene variants) inherited from its ...

Explain the significance of genetic factors, environmental factors, and pathogenic agents to health from the perspectives of both individual and public health.

SC.912.L.14.6

A. Cells have characteristic structures and functions that make them distinctive.

B. Processes in a cell can be classified broadly as growth, maintenance, reproduction, and homeostasis.

C. Life can be organized in a functional and structural hierarchy ranging from cells to the biosphere.

D. Most multicellular organisms are composed of organ systems whose structures reflect their particular function.

Cardiac Exam I: Checking the Chest First

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