1 Symptoms#F186

CARDIOVASCULAR CARDIOVASCULAR SEMIOLOGYSEMIOLOGY

Dr. Nechita Alexandru

Cardiovascular death burden Cardiovascular death burden

Mortalitate anuala prin boli cariovasculareMuller-Nordhorn et al, EHJ, May 2008

CARDIOVASCULAR MEDICINECARDIOVASCULAR MEDICINE

CLINICAL CARDIOLOGY

INTERVENTIONAL INTERVENTIONAL CARDIOLOGYCARDIOLOGY RHYTHMOLOGY

ACUTE CARDIAC CARE

CARDIOLOGY IMAGING

CARDIAC REHABILITATION

CARDIOVASCULAR SURGERY

CARDIOVASCULAR ASSESMENTCARDIOVASCULAR ASSESMENT

““FIVE FINGER APPROACHFIVE FINGER APPROACH””

ANAMNESISANAMNESIS

PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

ECGECG

CARDIOVASCULAR IMAGINGCARDIOVASCULAR IMAGING

LABORATORY TESTSLABORATORY TESTS

ECHOCARDIOGRAPHYECHOCARDIOGRAPHY

CORONARY ANGIOGRAPHYCORONARY ANGIOGRAPHY

CARDIAC CTCARDIAC CT

CARDIAC MRICARDIAC MRI

SYMPTOMSSYMPTOMS

DISPNOEADISPNOEA

PALPITATIONSPALPITATIONS

PAIN PAIN

SYNCOPESYNCOPE

COUGHCOUGH

CARDIOVASCULAR SYSTEM SEMIOLOGY

CARDIAC CAUSE DISPNOEACARDIAC CAUSE DISPNOEA

1.1. APPEARANCE CONDITIONSAPPEARANCE CONDITIONS

2.2. WHICH PERIOD OF BREATH IS AFFECTEDWHICH PERIOD OF BREATH IS AFFECTED

3.3. RESPIRATORY RATERESPIRATORY RATE

4.4. OTHER ACOMPANYING SYMPTOMSOTHER ACOMPANYING SYMPTOMS

5.5. RELIEF CONDITIONSRELIEF CONDITIONS

6.6. ALTE SIMPTOME CARDIACE CEALTE SIMPTOME CARDIACE CEPRECED / INSOTESC / URMEAZAPRECED / INSOTESC / URMEAZA

7.7. REAPPEARANCE CONDITIONSREAPPEARANCE CONDITIONS


CARDIAC DISPNOEACARDIAC DISPNOEAAPPEARANCE CONDITIONSAPPEARANCE CONDITIONS

•• AT EFFORTAT EFFORT

•• AT RESTAT REST

CONTINOUS CONTINOUS -- ORTHOPNEEAORTHOPNEEA

PAROXYSMAL PAROXYSMAL –– ACUTE PULMONARY ACUTE PULMONARY

EDEMAEDEMA

-- CARDIAC ASTHMA CARDIAC ASTHMA


CARDIAC DISPNOEACARDIAC DISPNOEACONDITIONS OF APPEARANCECONDITIONS OF APPEARANCE

NYHA CLASSIFICATION NYHA CLASSIFICATION

GRD. I GRD. I BIG EFFORT BIG EFFORT (WALKING FAST)(WALKING FAST)

GRD. II GRD. II MEDIUM EFFORTMEDIUM EFFORT (WALKING ON (WALKING ON

PLANE SURFACE)PLANE SURFACE)

GRD. III GRD. III SMALL EFFORTS SMALL EFFORTS (DRESSING, (DRESSING,

PERSONAL MORNING HYGENE)PERSONAL MORNING HYGENE)

GRD. IV GRD. IV AT REST AT REST (ORTHOPNEA)(ORTHOPNEA)


Intrapulmonary pressure distributionIntrapulmonary pressure distribution

CARDIOVASCULAR SYSTEM SEMIOLOGYphysiopathology

p A > p a > p v

p a > p A > p v

p a > p v > p A

PALPITATIONSPALPITATIONS

SUBJECTIVE SENSATION CONSISTING OF CONSCIOUS SUBJECTIVE SENSATION CONSISTING OF CONSCIOUS

PERCEPTION OF THE HEART BEATSPERCEPTION OF THE HEART BEATS

PHYSICAL EXAMPHYSICAL EXAM

NOTHINGNOTHING VERY SEVEREVERY SEVERE

AIM OF EXAM: TO PERCIEVE THE RHYTHM DISTURBANCEAIM OF EXAM: TO PERCIEVE THE RHYTHM DISTURBANCE


PALPITATIONSPALPITATIONSOBJECTIVES OBJECTIVES --ANAMNESISANAMNESIS

1.1. ONSET: ONSET: SUDDEN OR PROGRESSIVE, EFFORTSUDDEN OR PROGRESSIVE, EFFORT

2.2. CAHRACTHER: CAHRACTHER: REGULAR OR IREGULAR RATEREGULAR OR IREGULAR RATE

3.3. RATE: RATE: SUBJECTIVE OR MEASUREDSUBJECTIVE OR MEASURED

4.4. DURATIONDURATION

5.5. ACCOMPANYING PHENOMENA.ACCOMPANYING PHENOMENA.

6.6. CONDITIONS OF CESSATION.CONDITIONS OF CESSATION.

7.7. PHYSICAL EXAM WHITH OBJECTIVE PROOF OF ARHYTHMIA. PHYSICAL EXAM WHITH OBJECTIVE PROOF OF ARHYTHMIA.


CARDIAC PAINCARDIAC PAIN

1.1. CONDITIONS OF APPEARANCECONDITIONS OF APPEARANCE

2.2. LOCATIONLOCATION

3.3. INTENSITYINTENSITY

4.4. DURATIONDURATION

5.5. IRRADIATIONIRRADIATION

6.6. CONDITIONS OF CHANGECONDITIONS OF CHANGE

7.7. DISPARITION, REAPARRITION AND DISPARITION, REAPARRITION AND ACCOMPANYING PHENOMENA. ACCOMPANYING PHENOMENA.


CARDIAC PAINCARDIAC PAIN

STABLE ANGINA.STABLE ANGINA.

ACUTE CORONARY SYNDROMESACUTE CORONARY SYNDROMES

““ ATRIAL ITCH ATRIAL ITCH ““ (VAQUEZ)(VAQUEZ)

HEART FAILUREHEART FAILURE

AORTIC DISEASESAORTIC DISEASES

PULMONARY EMBOLISM & INFARCTIONPULMONARY EMBOLISM & INFARCTION

INTERMITANT CALUDICATIONINTERMITANT CALUDICATION


CHEST PAIN IN CHEST PAIN IN STABLE ANGINASTABLE ANGINAUSSUALLYUSSUALLY

1.1. APPEARANCE:APPEARANCE: EFFORTEFFORT

2.2. LOCATION: LOCATION: RETROSTERNAL ON A LARGE AREARETROSTERNAL ON A LARGE AREA

3.3. INTENSITY:INTENSITY: SMALL SMALL --MEDIUMMEDIUM

4.4. DURATION:DURATION: ≤≤ 10 10 minuteSminuteS

5.5. IRRADIATION:IRRADIATION: LEFT ARM LEFT ARM

6.6. CONDTIONS OF CHANGE:CONDTIONS OF CHANGE: NITROGLYCERINNITROGLYCERIN

7.7. DISAPEARANCE REPEAT:DISAPEARANCE REPEAT: EFFORT STOP, USSUALLY AT EFFORT STOP, USSUALLY AT

THE SAME EFFORT. THE SAME EFFORT.


CHEST PAIN IN A.C.S.CHEST PAIN IN A.C.S.USUALLYUSUALLY

1.1. APPEARANCE:APPEARANCE: EFFORT EFFORT –– RESTREST

2.2. LOCATION:LOCATION: RETROSTERANL ON A LARGE AREARETROSTERANL ON A LARGE AREA

3.3. INTENSITY:INTENSITY: MEDIUM MEDIUM –– HIGH.HIGH.

4.4. DURATION:DURATION: 20 20 -- 30 minutes or MORE30 minutes or MORE

5.5. IRRADIATION:IRRADIATION: LEFT ARMLEFT ARM

6.6. ALLECIATION CONDIT.:ALLECIATION CONDIT.: NOT NITROGLYCERYNNOT NITROGLYCERYN

7.7. CESSATION, REPEAT:CESSATION, REPEAT: MORPHINE, IV.NTGMORPHINE, IV.NTGTRIGGERS SHOCKTRIGGERS SHOCK

CARDIAC SIGNSCARDIAC SIGNS


CHEST PAIN IN ATRIAL ITCHCHEST PAIN IN ATRIAL ITCH

1.1. APPEARANCE:APPEARANCE: EFFORT or left EFFORT or left atrialatrial overloadoverload

2.2. LOCATION:LOCATION: LEFT LEFT -- INTERSCAPULOVERTEBRALINTERSCAPULOVERTEBRAL

3.3. INTENSITY:INTENSITY: MEDIUMMEDIUM

4.4. DURATION:DURATION: HOURS or DAYSHOURS or DAYS

5.5. IRRADIATION:IRRADIATION: NONO

6.6. MODIFICATION CONDITIONS:MODIFICATION CONDITIONS: increases in inspirationincreases in inspiration

7.7. CESSATION , :CESSATION , : DISAPPEARS WHEN ATRIAL DISAPPEARS WHEN ATRIAL

OVERLOAD DECREASES, ITOVERLOAD DECREASES, IT’’S REPRODUCIBLE. S REPRODUCIBLE.


PAIN IN PAIN IN HEART FAILUREHEART FAILURE

1.1. APPEARANCE:APPEARANCE: EFFORT or RESTEFFORT or REST

2.2. LOCATION:LOCATION: RIGHT UPPER QUADRANTRIGHT UPPER QUADRANT--EPIGASTRIUMEPIGASTRIUM

3.3. INTENSITY:INTENSITY: VARIABLEVARIABLE

4.4. DURATION :DURATION : hours or dayshours or days

5.5. IRRADIATION:IRRADIATION: SOMETIMES POSTERIORSOMETIMES POSTERIOR

6.6. CHANGE CONDITIONS: CHANGE CONDITIONS: PALPATION OR DEEP INSPIRATIONPALPATION OR DEEP INSPIRATION

7.7. DISAPPEARANCE, REPEAT:DISAPPEARANCE, REPEAT: WHEN STASIS WHEN STASIS

DECREASES.DECREASES.


CHEST PAIN IN AORTIC DISSECTIONCHEST PAIN IN AORTIC DISSECTION

1.1. APPEARANCE:APPEARANCE: SUDDEN SUDDEN

2.2. LOCATION :LOCATION : RETROSTERNAL, LARGE AREARETROSTERNAL, LARGE AREA

3.3. INTENSITY:INTENSITY: HIGHHIGH

4.4. DURATION:DURATION: 2020--30MINUTES OR MORE. 30MINUTES OR MORE.

5.5. IRRADIATION:IRRADIATION: POSTERIOR OR DOWNWARDSPOSTERIOR OR DOWNWARDS

6.6. CONDITIONS OF CHANGE: CONDITIONS OF CHANGE: NOT NITROGLYCERIN NOT NITROGLYCERIN

7.7. DISAPPEARANCE, REPEAT:DISAPPEARANCE, REPEAT: MORPHINEMORPHINESHOCK GENERATINGSHOCK GENERATING

CARDIAC SIGNS. CARDIAC SIGNS.


CHEST PAIN IN APE AND PULMONARY INFARCTIONCHEST PAIN IN APE AND PULMONARY INFARCTION

1.1. APPEARANCE :APPEARANCE : SUDDENSUDDEN

2.2. LOCATION:LOCATION: PULMONARY AREAPULMONARY AREA


4.4. DURATION :DURATION : VARIABLEVARIABLE

5.5. IRRADIATION:IRRADIATION: NONO

6.6. CHANGE CONDITIONS: CHANGE CONDITIONS: PREFERENTIAL DECUBITUSPREFERENTIAL DECUBITUS

7.7. DISPARITION, REPEAT:DISPARITION, REPEAT: ANXIETY SHOCK ANXIETY SHOCK (RIGHT HEART FAILURE (RIGHT HEART FAILURE

PHENOMENA. PHENOMENA.


CHEST PAIN IN ACUTE PERICARDITISCHEST PAIN IN ACUTE PERICARDITIS

1.1. APPEARANCE :APPEARANCE : SUDDENSUDDEN

2.2. LOCATION:LOCATION: RETROSTERNAL, PRECORDIALRETROSTERNAL, PRECORDIAL


4.4. DURATION :DURATION : HOURSHOURS--DAYSDAYS

5.5. IRRADIATION:IRRADIATION: NECK, LEFT UPPER HANDNECK, LEFT UPPER HAND

6.6. CHANGE CONDITIONS: CHANGE CONDITIONS: PREFERENTIAL PREFERENTIAL

DECUBITUSDECUBITUS,DEEP INSPIRATION, ANTERIOR LEAN OF THE BODY,DEEP INSPIRATION, ANTERIOR LEAN OF THE BODY

7.7. DISPARITION, REPEAT:DISPARITION, REPEAT: PAIN KILLERS, NSAIDS, PAIN KILLERS, NSAIDS,

CORTISONECORTISONE


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