"Rule of four" in Cardiovascular system examination: ❤️ 4 examinations for Assessment of CVS status- 1. Pulse 2. BP 3. JVP 4. Precordium ❤️ 4 Examinations about precordium- 1. inspection 2. Palpation 3. percussion 4. Auscultation ❤️ 4 main points to see on inspection- 1. Bulging of precordium 2. Visible apex beat 3. Visible vein 4. Scar mark ❤️ 4 main points on palpation- 1. Position and character of apex beat 2. Thrill (palpable murmur) 3. Left parasternal heave 4. P2 palpation ❤️ 4 Characters of apex beat- 1. Normal 2. Tapping eg.MS 3. Heaving- pressure overload eg.AS ,LVF 4. Thirsting- volume overload eg.AR ,MR ❤️ 4 points in Auscultation- 1. Auscultation of 4 areas - a. Mitral area b. Tricuspid area c. pulmonary area d. Aortic area 2. added sound 3. Murmur 4. Base of the lung ❤️ 4 main types of murmur - 1. Mid diastolic eg. MS, TS 2. Pan Systolic eg. MR, TR 3. Ejection Systolic eg.PS ,AS 4. Early diastolic eg. PR ,AR ❤️ 4 procedures to auscultation of Murmur- 1. Palpate the position of Apex beat 2. Positioning of the patient - left lateral position eg.MS - Supine position eg. TS - sitting and leaning forward eg. AS, PS 3. Left hand on carotid pulsation 4. Auscultation by Bell(MS)or Diaphragm. ❤️ 4 Peripheral sign in case of Aortic Regurgitation - 1. 3 Pulse - a. Carotid dancing pulse b. Capillary pulse c. Collapsing pulse 2. 3 BP - a.high Systolic pressure b.low diastolic pressure c.wide pulse pressure 3. 3 murmur - a.pulmonay area - Early diastolic murmur b. Aortic area- Ejection systolic murmur c. Mitral area- Mid diastolic murmur 4. Peripheral pistol shot mur
