@gaymalephysicals I agree 100% on A) Palpation and auscultation of femoral arteries. Very erotic. Thorough as well. Also to the abdominal aorta. That one takes a trained ear for some patients. Carotids, of course. All pulse points should be palpated and noted, of course, if remarkable. I palpate, bilaterally, radials, brachials, and femorals while auscultating the apical impulse of my patient. Doing so gives you a very good indication of any vascular deficiencies if any, and if the need to investigate further with ultrasound examination is necessary.
B) The Orthostatic, or lying/standing test is a beautiful test. I perform this on all patients, noting HR an BP upon taking the initial supine position. Systolic and more markedly, diastolic pressure will both raise, initially. Markedly in some. HR should drop initially. At two minutes HR and BP. Both should be close to resting, sitting measurements. The patient should remain at rest, quietly, no movement. Head should be directly on the examination table. You want your patient FLAT.
After the five + minutes I take HR and BP measurements again. After resting the left arm of the pressure cuff inflation for a good 30 seconds or so, I reinflate cuff to above systolic and have the patient as quickly and smoothly as possible, take a standing position. This test best performed with an assistant unless you have beat to beat BP and HR capabilities. More likely though will be an apical HR, which should increase markedly within four beats of standing, via stethoscopic examination, and immediate BP determination, auscultatory, with arm cuff and sphygmomanometer. It is difficult to perform these measurements immediately, also maintaining the safety of your patient, as some will grow faint, light-headed, or outright lose consciousness. All of which, indicate a positive for Orthostasis. A positive naturally warrants further investigation. Head up tilt test with beat to beat capabilities, initially. *1
Upon rising to stand position with no subjective effects, I take immediate BP and HR. I take HR and BP measurements on the minute, every minute out till 6,7 minutes if indicated. At 3 minutes, patients physiological markers should be back to baseline.
I also enjoy performing the Valsalva Maneuver in the Supine, 45 Deg., 70 Deg.--Extreme blood pressure overshoot at initial release., and sitting. Use of a manometer to let patient visualize, and you to ascertain unequivocally they maintained a positive pressure of at least 40 mmHg for 20 seconds is recommended, but not necessary.
The 3 minute, Dundee Step Test is also effective in ferreting out any Cardiovascular Markers.
Footnotes:
*1 I would love to have a physician perform all of these stressors and more on me. Just writing these tests out caused a few changes in my physiology.