Prof. Dr. dr. Idris Idham, Sp.JP9K), FACC, FESC, FIHAPEMERIKSAAN FISIK JANTUNGDepartemen of Kardiologi dan Kedokteran Vaskuler Fakultas Kedokteran Universitas IndonesiaPusat Jantung Nasional Harapan Kita

Meraba Arteri KarotisMeraba Arteri KarotisJANGAN LUPA AUSKULTASI!!MMP

Inspeksi Vena Jugularis MMP

Anatomi V.JugularisMMP

Inspeksi pulsasi Vena JugularisMMP

Skema pengukuran JVPMMP

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Examine Precordium (Cardiac)Inspect the precordium with the pt sitting at 45 degree angle with shoulder horizontal.Look for scars,visible pulsation and chest deformityLay your whole hand flat over the precordium to obtain a general impression of cardiac activityLocate the apex beat by laying your finger on the chest paralel to the rib spaces.If you can not feel it,ask the pt to roll onto the left sideFeel for the right ventricle using the heel of your hand applied firmly to the left parasternal position.Ask the pt to hold his breath in expiration.Palpate the thrill at the apex and both sides of the sternum.If you hear a murmur feel again for a thrill using the flat of your fingers while the pt is in the optimum positionMMP

Examine PrecordiumInspect the precordium with the pt sitting at 45 degree angle with shoulder horizontal.Look for scars,visible pulsation and chest deformityLay your whole hand flat over the precordium to obtain a general impression of cardiac activityLocate the apex beat by laying your finger on the chest paralel to the rib spaces.(its about 2-2,5cm in diameter)If you can not feel it,ask the pt to roll onto the left sideFeel for the right ventricle using the heel of your hand applied firmly to the left parasternal position.Ask the pt to hold his breath in expiration.Palpate the thrill at the apex and both sides of the sternum.If you hear a murmur feel again for a thrill using the flat of your fingers while the pt is in the optimum positionChizner MA.The Diagnosis of Heart Disease by Clinical Assesment Alone.Current Problems in Cardiology;26:285-380,2001MMP

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Relation between Heart & Chest wallMMP

Lines on Chest wallMMP

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Precordium Catat/laporkanApakah ada kelaian bentuk dada:pectus excavatum,carinatum,Barrel chest atau normal,sikatriks bekas operasi/pacu jantungIktus kordis terlihat/teraba di garis apaApakah teraba normal,heaving,tapping atau difus/diskinetikApakah teraba thrillBesar jantung berdasarkan inspeksi,palpasi dan perkusiMMP

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Palpasi Jantung

Palpasi Jantung

(How to percuss the heart)Locate midsternal line,r/l sternal line,r/lmcl,left anterior axillary line,posterior axillary line and mid axillary lineFor the normal size heart Locate the lung-gastric border in the mc line(in the middle of normal respiration),Locate point at 2cm above,lung-gastric border and percuss from lateral left to medial.Point the sound changing from sonor to dull(this is the Left border of the heart).For a big heart do it from the mid or lateral axillary lineLocate the right lung-liver border in the rmcl (in the middle of normal respiration),,Locate 2 cm above,lung-liver border and percuss from lateral right to medial and point where rhe sound change from sonor to dull.(This is the Right border of the heart)Percus from up side of the left sternal line to point the up side heart border(up side border)Percuss from the left shoulder to sentral of the heart to judge the Left Atrial/Pulmonal artery enlargement and also from up side down at the para-sternal line.Note:In most case palpation has replaced percussiosion for estimation of cardiac size.If you can not feel the apical impulse,hawever, percussion may suggest where to search it.Occasioally percussion may be your only tool(Sukaton U(Editor).Petunjuk tentang Riwayat Penyakit dan Pemeriksaan Jasmani,Bagian I.P.D FKUI,Jakarta,cetakan ke2,1986.

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Auskultasi JantungMMP

Sinkronisasi Bunyi Jantung I dan Pulsasi A.KarotisMMP

Memperjelas bunyi jantung dan murmur Aorta

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Auskultasi jantungIdentifikasi bunyi jantung 1 dan 2Identifikasi bunyi jantung 3 dan 4(fase diastolik)Bunyi jantung tambahan: Snap atau KlikMurmur(Bising):Sistolik 6 gradasi atau diastolik(early,mid atau presistolik)MMP

Gradasi bising sistolik1.Heard by an expert in optimum condition2.Heard by non-expert in optimum condition3.Easily heard,no thrill4.A loud murmur,with a thrill5.very loud.often heard over wide area with thrill6.Extreemily loud,heard without sthetoscopeMMP

MACAM-MACAM BISING

Terima Kasih

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