CARDIOVASKULAR EXAMINATION (Vascular Examination)

Main ideas / lessons conveyed

• Why vascular examination matters for general practitioners

  • Vascular examination is part of GP competency (described as “level 4A”).
  • Vascular diseases are common worldwide.
  • Examples mentioned:
    • Acute limb ischemia with reported mortality around 10–25%.
    • Chronic arterial occlusion diseases, including Peripheral Artery Disease (PAD), increasing with roughly 15% growth.
    • Chronic venous disease / insufficiency, increasing up to about 40%.

• Clinical purposes of vascular examination

  1. Support anamnesis and help establish a diagnosis.
  2. Evaluate outcomes/history of previous illness.
  3. Monitor therapy, especially in arteriocclusion/PAD cases.

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Methodology / instructions: Vascular examination steps (as presented)

A. Context / patient case (for applying the technique)

• Patient complaints

  • Pain in the tips of fingers and toes for almost 1 year.
  • Pain described as constant: initially improved, then returned.
  • Additional history: smoking for about 6 months (and diabetes/cholesterol/weight history is referenced as having been checked previously).

• Clinician suspicion

  • The clinician suspects a vascular flow problem.
  • Later described as likely related to Burger’s disease (context suggests Buerger/Burger-type disease associated with heavy smoking and poor circulation).

• Goal

  • Confirm suspected vascular disease and determine severity before treatment/referral.

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B. Upper extremity vascular examination (instruction sequence)

1. Inspection

   • Look at the fingers for discoloration:
     • Example described: finger turning black, and/or cyanosis.

2. Capillary refill time (CRT)

   • Press the finger for 5 seconds until color becomes pale.
   • Release and observe whether color returns to red.
   • Interpretation given:
     • CRT > 2 seconds suggests impaired perfusion (especially in fingers with gangrene/cyanosis).
   • Repeat on the other hand.

3. Radial artery palpation

   • Palpate as described (from a distal area toward the lateral side).
   • Assess:
     • Pulse strength
     • Whether the artery wall feels hard

4. Other artery checks as indicated

   • For arteries that are difficult to assess:
     • Compare to the other hand.

5. Brachial artery examination

   • Palpate in the sulcus between biceps and triceps.
   • Assess:
     • Pulse
     • Hardness of arterial wall
   • Also mention checking the cubital pulse.

6. Lymph node assessment (included in the workflow)

   • Check for enlarged lymph nodes:
     • Size
     • Tenderness/pain
     • Location between described landmarks (between the biceps/triceps sulcus; about 3 cm from the contralateral side as stated).

7. Temperature assessment

   • Compare sides.

8. Auscultation (listening for bruits)

   • Done because vascular narrowing/blockage is suspected.
   • Specifically auscultate the brachial artery.
   • Assess for bruits:
     • Bruits can occur in arterial narrowing/arteriosclerosis
     • Bruits can also occur in aneurysm

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C. Lower extremity vascular examination (instruction sequence)

1. Inspection

   • Inspect legs:
     • distribution of hair
     • skin color:
       • hyperpigmentation?
       • reddish?
       • pale?
       • cyanosis?
   • Inspect toes/nails:
     • thickened nails
     • deformities (cupping fingers mentioned)
   • Don’t forget to inspect the back of the foot.

2. Palpation

   • Check temperature of both legs (compare sides).
   • Check capillary refill time of the feet.
   • Check abdominal area:
     • palpate for pulsation in the abdominal aorta, suggesting aneurysm

3. Auscultation

   • Assess for narrowing/blockage:
     • start from the femoral artery and listen toward the described region.
   • Also auscultate along the public/groin-related region as described to facilitate examination.

4. Popliteal and distal arterial palpation

   • Popliteal fossa:
     • palpate slightly laterally using 2–3 fingers
     • assess:
       • pulse presence
       • arterial wall hardness
   • Dorsalis pedis arteries are mentioned, along with the posterior tibial region.

5. Edema assessment (when swelling is suspected)

   • If edema is present:
     • palpate in the edema area.
   • If unsure:
     • measure suspected areas.
   • Measurement points and thresholds given:
     • Measure at the ankle area.
     • Measure the calf for both legs.
     • Suspect edema if:
       • ankle region difference is around 1 cm
       • and calf difference is > 2 cm
   • Confirmation by pitting:
     • Press for 5 seconds, then release.
     • If a depression remains → suggests pitting edema
     • If it returns immediately → less likely edema

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Clinical reasoning / follow-up actions in the case

• The clinician links symptoms and exam findings to poor arterial blood flow, strongly associated with smoking.

• Plan / next steps

  • Recommend supporting examinations such as:
    • Ultrasound
    • Arteriography (subtitles reference “arthrography/arthrography,” but the context is vascular imaging)
  • Refer to vascular surgery.

• Treatment advice mentioned

  • Stop smoking to reduce worsening risk.
  • Avoid cholesterol-rich foods to reduce risk of arteriosclerosis progression.
  • Medications mentioned (details limited):
    • Painkiller first
    • Possible vasodilators and blood thinners—to be decided after specialist evaluation.

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Speakers / sources featured (as identifiable from the subtitles)

• Narrator / Presenter (introduces the skills material and explains the vascular examination topic)
• Doctor Yunan (supervising clinician/doctor)
• Doctor on duty at the polyclinic (introducing clinician who performs/explains parts of the exam; appears to speak with Doctor Yunan)
• Patient (“Sir”) / “Mr. Adam”
• Vascular surgery department / specialist doctor (referenced as the receiving service for referral)