13.10 : Assessment of the Cardiovascular System II: Inspection

Inspection is the initial step in assessing the cardiovascular system. It involves a detailed visual examination that provides crucial information about a patient's circulatory and cardiac health. This systematic process, conducted from head to toe, helps identify signs of cardiovascular conditions by observing physical appearance, skin and mucous membranes, jugular and carotid pulsations, chest symmetry, and the condition of the extremities.

Head and Neck

1. General Appearance: With the patient in a supine position, assess their body build (note any obesity or cachexia) and look for signs of distress, such as dyspnea, dizziness, and fatigue.
2. Skin and Mucous Membranes: Inspect for cyanosis (bluish discoloration), pallor (paleness), erythema (redness), and xanthelasma (yellow cholesterol deposits around the eyes).
3. Jugular and Carotid Inspection: Position the patient at a thirty- to forty-five-degree angle (semi-Fowler position). Inspect for jugular venous distension (JVD), which can indicate right-sided heart failure or elevated central venous pressure. Assess carotid pulsations; exaggerated pulsations can indicate aortic regurgitation or hyperdynamic circulation.

Upper Body

1. Chest: Inspect for symmetry, visible veins (indicating increased venous pressure), surgical scars, or deformities. Note any visible pulsations or heaves (precordial movements), which may indicate underlying heart conditions like left ventricular hypertrophy.
2. Hands: Look for tar staining (common in smokers) and xanthomata (yellowish fat deposits indicating high cholesterol levels). Examine the nails for signs of clubbing, which is noticed by the disappearance of the usual angle between the nail and the nail bed. This could signify ongoing hypoxia, congenital heart conditions, or infectious endocarditis.

Lower Body

1. Extremities: Examine for edema (swelling), varicose veins (enlarged, twisted veins), and venous stasis (poor blood flow), all of which may suggest chronic venous insufficiency or heart failure.

Additional Observations

1. Scars and Deformities: Observe for surgical scars indicating past cardiovascular procedures.
2. Malar Flush: Redness on the cheeks is often associated with mitral stenosis.
3. Splinter Hemorrhages: Red-brown lines under the nails indicating endocarditis.
4. Janeway Lesions: Non-tender hemorrhagic lesions on the palms or soles.
5. Osler's Nodes: Tender, red-purple lumps on fingers or toes.