Cardiac History & Examination
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Transcript of Cardiac History & Examination
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Cardiac History & ExaminationCardiac History & Examination
Jamil MayetJamil MayetConsultant CardiologistConsultant Cardiologist
St Mary’s HospitalSt Mary’s Hospital
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Chest Pain• Character• Radiation• Relation with inspiration• Provocation• Grading
– Canadian Cardiovascular Society• I - Ordinary activity does not provoke• II - Slight limitation of ordinary activity• III - Marked limitation of ordinary activity (<1 flight steps)• IV – Inability to carry out physical activity
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Dyspnoea
• Exertional• Orthopnoea• Paroxysmal nocturnal dyspnoea• NYHA Classification
– I - No SOB– II - SOB on severe exertion– III - SOB on mild exertion– IV – SOB at rest
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Other Symptoms
• Palpitations– Regular / irregular– Fast / slow– Extra beats
• Syncope– Usually sudden and brief if cardiac cause– “Stokes-Adams” attacks
• Fatigue• Oedema
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General examination
• Comfort / distress / resp rate• Scars• Bruising / needle marks• Chest wall motions• JVP / ankle oedema• IV infusions• Diabetic food / drinks
KEEP YOUR EYES OPEN
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Hands
• Clubbing– Cyanotic Congenital Heart Disease– Bacterial Endocarditis
• Peripheral stigmata of endocarditis– Splinter haemorrhages– Osler nodes– Janeway lesions
• Peripheral cyanosis– Cardiac / Respiratory / Vasoconstriction
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Pulse
• Radial– Rate– Rhythm– Volume– (Character)
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Pulse
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Blood Pressure
Appropriate cuff size
Palpate first
Slowly deflate
Korotkoff V
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Eyes and mouth
• Anaemia
• Jaundice
• Xanthelesma
• Corneal arcus
• Central cyanosis
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Carotid pulse
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Jugular Venous Pressure
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Jugular Venous Pressure
• A wave – atrial systole
• X descent – end of atrial systole
• C wave – transmission of rapidly increasing RV pressure just before TV closes
• V wave – venous return to RA during ventricular systole
• Y descent – TV opening
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Jugular Venous Pressure
• Large a waves– Pulm ht, pulm stenosis, tricuspid stenosis
• Cannon a waves– A wave against closed TV
• CHB, VT, Junctional rhythm
• Giant v waves– Tricuspid regurgitation
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Praecordium
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Praecordium
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Auscultation
Apex
LSE
Pulm
Aortic
1st sound
2nd sound
Systole
Diastole
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Auscultation
Radiation of murmurs
Left side with bell at apex
Sat forward in expiration
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Murmurs
• Systolic– Ejection
• Aortic, (pulmonary), flow murmurs
– Pan systolic• MR, (TR), (VSD)
• Diastolic– Early
• AR, (PR)
– Mid• MS, (TS)
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Peripheral pulses