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Like the pulmonary system, examination of the cardiac system requires optimal use of auditory, observational, positional, tactile, auscultatory, and medical information. Perturbation of initial examination findings with different body positions or maneuvers may provide important observational, tactile, and auscultatory findings that may yield important information that could (1) direct further examination techniques, (2) direct treatment techniques, and (3) provide important prognostic information. This chapter will review a variety of practical examination techniques and specific maneuvers that may help to direct and predict the effects of examination and treatment techniques. Much of this information is alluded to in the patient note of Box 10-1.
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BOX 10-1 Examination Techniques and Specific Methods to Determine the Disablement of Cardiac Disorders and Direct and Predict Physical Therapy: A Patient Case Example*
Why are you here today?
Have you been diagnosed with a cardiac disorder in the past?
Have you had any special tests to examine your heart like an electrocardiogram (ECG), stress test, echocardiogram, or cardiac catheterization?
Do you experience angina or shortness of breath at rest, only with activity/exercise, or both at rest and with activity/exercise?
If you experience angina or become short of breath during activity or exercise, could you please describe the type of activity or exercise, which produces your angina or shortness of breath?
Can you describe your angina or shortness of breath? Can you help me understand your angina or shortness of breath by pointing to the numbers 1 through 4 to describe the level of angina you experience at rest and exercise or by pointing to your level of shortness of breath using this 10-point scale or by marking this Visual Analog Scale?
Could I feel your pulse to determine your heart rate and the strength of your pulse?
Could I place this finger probe on your index finger to obtain an oxygen saturation measurement?
Could I place these electrodes on your chest to obtain a simple single-lead ECG?
Could I take your blood pressure while you are seated and then compare it to the blood pressure while you are lying down and then standing? I would also like to observe your pulse, oxygen saturation, ECG, and symptoms when you are lying down and standing.
Could I listen to your heart and lungs with my stethoscope? While I do this I will concentrate on watching your ECG so that I can identify your heart sounds and any changes in the ECG while you are breathing deeply when listening to your lungs.
Could I place one of my hands on your stomach and one hand on your upper chest to determine how you breathe?
Could I place my hands on the lowermost ribs on each side of your chest to determine how you breathe?
Could I place my hands on your back to determine how you breathe?
Could I wrap my tape measure around your chest at several different sites to determine how you breathe?...