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The cardiovascular exam includes evaluation of the heart and peripheral vascular system. It is performed in several settings:
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As part of a screening evaluation for asymptomatic disease in healthy or at-risk populations
When patients present with symptoms or findings (eg, chest pain, shortness of breath, edema, slow-to-heal extremity wounds) for which cardiovascular disease might be the underlying driver
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The exam space should be quiet, well lit, private, and allow you to adequately expose the chest to facilitate the exam. Sometimes, the situation is not ideal (eg, a busy emergency department), in which case, do the best that you can, and reassess later if/when the physical space changes.
The patient should rest supine with the upper body elevated to approximately 30 degrees. Most exam tables have an adjustable top. If not, use 2 or 3 pillows.
Although assessment of pulse and blood pressure is discussed in the vital signs chapter (Chapter 3), they are important elements of the cardiovascular exam. See Chapter 3 for additional information.
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Gown Management and Appropriately and Respectfully Examining Your Patients
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There are several sources of discomfort related to the physical exam, including:
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People are often uncomfortable, in general, exposing any body part, even more so if it is in a sensitive area.
In order to perform an accurate exam, exposure is critical.
The entire process requires touching people with whom you may have little acquaintance.
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Keys to performing a sensitive and thorough exam include the following:
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Explain what you are doing (and why) before doing it. Empower the patient to stop the exam or opt out if they are uncomfortable, following the principles of trauma-informed care discussed in the chapters on the breast (Chapter 10) and genital exams (Chapters 9 and 11).
Expose the minimum amount of skin necessary to do the job; this requires “artful” use of gowns and drapes (Figure 6-1).
As much as possible, avoid examining through gowns or clothing. It adds another layer between your stethoscope, eyes, hands and the heart, decreasing the chances that you’ll appreciate findings.
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When examining the heart and lungs of female patients (Figure 6-1):
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Ask the patient to remove their bra prior to examining the chest area.
Expose the left side of their chest to the extent needed.
Enlist the patient’s assistance, asking them to raise their breast to a position that ...