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Old 10-07-2012
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Stethoscope Cardiac Exam; Sitting and Lying Position!

Hi every one
In a cardiac case do we need to do heart exam in both sitting & lying position?
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Old 10-07-2012
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I thought about this a lot until I tried it with the partner It literally only takes about additional 30 seconds to ask the pt to lie down and to listen to his heart again (when his gown is already lowered after you just listened to his heart and lungs sitting). Immediately after that you can check for JVD (cause you need SP to be supine for that and you're gonna ask him to lie down anyway).
I assume that on purely cardiac case like HTN follow-up supine heart auscultation is on the checklist. I might be wrong though.
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Old 10-21-2012
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Default My thoughts

Personally I did cardiac exam only in the sitting position. However if you do have lots of time left over it will not hurt you to do a more thorough exam with the patient lying down as well. With a cardiac case you do have to remember to do other things other than auscultate such as: Palpation of PMI (pt maximal impulse), Percussion of heart borders, palpation of heart for thrills and check for JVD and Carotid auscultation. For certain auscultate at least once, twice to be even more thorough. Also do not forget the auscultation of lungs and to check for any fluid in lungs. As always time is key so if you feel you are running out of time auscultating once and moving on to other parts of the physical is more important than auscultating the heart twice. Best of Luck!

Last edited by freebielady; 10-21-2012 at 02:50 PM. Reason: I hate typos :P
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Old 10-21-2012
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I don't think u need to percuss for the heart.
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Old 10-22-2012
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Default Not usually

Quote:
Originally Posted by add1 View Post
I don't think u need to percuss for the heart.
Usually you do not however the original question was asking about a typical cardiac case. In a case about any other complaint no you do not need to, auscultation is enough. However to do a thorough cardiac exam percussion of borders will determine if the heart is enlarged.
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Old 10-22-2012
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Yes, cardiac examination is best done in supine+sitting position in a cardiac case. It doesnt take that long.
And I imagine percussion of heart is not done routinely.
Correct me if I am wrong.
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