PROF. DR. M. AKBAR CHAUDHRY MBBS(Pb), MRCP(UK), FRCP(E), FRCP(London), FACC(USA), FCPS Principal & Professor of Medicine Azra Naheed Medical College Lahore.
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EXAMINATION OF CARDIOVASCULAR SYSTEM
PROF. DR. M. AKBAR CHAUDHRYMBBS(Pb), MRCP(UK), FRCP(E), FRCP(London), FACC(USA), FCPS
Principal & Professor of MedicineAzra Naheed Medical College Lahore
MEDICINE IS TO BE LEARNED BY EXPERIENCE;
IT IS NOT AN INHERITANCE; IT CANNOT BE REVEALED. LEARN TO SEE, LEARN TO HEAR, LEARN TO FEEL, LEARN TO SMELL AND TO KNOW THAT BY PRACTICE ALONE YOU CAN BECOME EXPERT.
MEDICINE IS LEARNT BY THE BEDSIDE, AND NOT IN THE CLASSROOM. LET NOT YOUR CONCEPTIONS OF THE MANIFESTATIONS OF DISEASE COME FROM WORDS HEARD IN THE CLASSROOM OR READ IN A BOOK, SEE AND THEN REASON, AND COMPARE AND CONTROL. BUT SEE FIRST.
(SIR WILLIAM OSLER)
CARDIOVASCULAR SYSTEM
MEDICAL PRACTICE IS NOT KNITTING AND WEAVING OR THE LABOUR OF HANDS, BUT IT MUST BE INSPIRED WITH SOUL AND FILLED WITH UNDER-STANDING AND EQUIPPED WITH THE GIFT OF KEEN OBSERVATION.
THE FACULTIES COMBINED WITH ACCURATE SCIENTIFIC KNOWLEDGE; ARE INDISPENSIBLE REQUISITES FOR PROFICIENT MEDICAL PRACTICE.
“MAIMORIDES”
A GOOD PHYSICIAN:
“ALL OF HIM SEE’S ALL OF HIM LISTENS, AND ALL OF HIM THINKS.”
AND
“A CARDIOLOGIST LISTENS TWICE OVER, ONCE TO THE HISTORY AND AGAIN WITH PARTICULAR ATTENTION THROUGH THE STETHOSCOPE.”
SYMPTOMS
1. DYSPNOEA (N.H.A.) (G1 – G4) - DYSPNOEA ON EFFORT
- DYSPNOEA AT REST- ORTHOPNOEA- PAROXYMAL NOCTURNAL DYSPNOEA (P.N.D)- CHEYNE – STOKE OR PERIODIC BREATHING
2. CHEST PAINA. ANGINA- SITE, RADIATION, CHARACTER, SEVERITY, DURATION, AGGRAVATING & RELIEVING FACTORS, ASSOCIATED PHENOMINA B. M. INFARCTIONC. PERICARDITISD. DISSECTING ANEURYSM OF AORTAE. PLEUREY PAINF. PUL. EMBOLISMG. FIBROSITIS, INTERCOSTAL MYALGIAH. MUSCULAR, EFFORT SYNDROME (ANXIETY)
HISTORY (ORIENTATED TO C.V.C)
SYMPTOMS
3. PALPITATIONS4. COUGH5. HAEMOPTYSIS6. OEDEMA7. FATIGUE8. LOSS OF CONSCIOUSNESS (SYNCOPY)9. G.I / U.G. SYMPTOMS
HISTORY (ORIENTATED TO C.V.C)
RHEUMATIC FEVER, CHOREADIPHTHERIAH/O DIABETES MELLITUSHYPERTENSIONSTONES, UTIOBSTETRIC HISTORY
- CIGARETTES- ALCOHAL
- DIET- JOB. STRESS
FAMILY HISTORY
OF RELATED DISEASES
PAST MEDICAL HISTORY
GENERAL INSPECTION OF THE PATIENTPOSTURE, HYPERTHYROIDISM, HYPOTHROIDISM
GENERAL PHYSICAL EXAMINATION
OBSERVE THE PATIENT FROM THE END OF THE BED
WASH YOUR HANDS INTRODUCE YOURSELF TO THE PATIENT
EXAMINATION OF HANDS (ANAEMIA)
GENERAL PHYSICAL EXAMINATION
CYANOSIS a. CENTRALb. PERIPHRAL
GENERAL PHYSICAL EXAMINATION
INSPECT THE EYES
GENERAL PHYSICAL EXAMINATION
INSPECT THE MOUTH & TONGUE
GENERAL PHYSICAL EXAMINATION
CLUBBING OF FINGERS
GENERAL PHYSICAL EXAMINATION
OSLERS NODES
GENERAL PHYSICAL EXAMINATION
SPLINTER HAEMORRHAGES CAPILLARY PULSATION & DIGITAL THROBING
PALMER ERYTHEMA
GENERAL PHYSICAL EXAMINATION
RHEUMATIC NODULES
SUPERA – TROCHLEAR L. NODES
TAKE THE RADIAL PULSE
GENERAL PHYSICAL EXAMINATION
1. RATE2. RHYTHM3. VOLUME4. CHARACTER5. PALPATION OF VESSEL WALL6. COMPARISON OF TWO RADIALS7. PALPATION OF RADIALS AND FEMORALS8. PALPATION OF ALL OTHER VESSELS9. COMPARISON OF RADIAL PULSE AND APEX BEAT (PULSUS
DEFICIT)10. TENSION…….??
PULSE EXAMINATION
RATERANGE 60 - 100/minAVERAGE 72/minBELOW 60/min (BRADYCARDIA)ABOVE 100/min (TACHYCARDIA)RELATIVE BRADY CARDIA
RHYTHMREGULARIRREGULAR- REGULARLY IRREGULAR- IRREGULARLY IRREGULAR- REGULAR WITH OCCASIONAL IRREGULARITY
VOLUMESMALL VOLUMELARGE VOLUME
PULSE EXAMINATION
NORMAL HYPERTENSION COLAPSING DICROTIC
BISFERIENS SMALL VOL. PLATEAU ANACROTIC
CHARACTER1. COLLAPSING / WATER HAMMER / CORRIGON2. PULSUS AL TERNANS3. PULSUS PARVUS4. BOUNDING PULSE5. PLATEAU PULSE, ANACROTIC PULSE6. PULSES PARADOXUS7. PULSES BIGEMINUS / TRIGEMINUS
PULSE EXAMINATION
CHECK FOR A COLLAPSING PULSE
GENERAL PHYSICAL EXAMINATION
DEPENDENT OEDEMA◦ ANKLES◦ FEET◦ LEGS◦ SACRUM
GENERAL PHYSICAL EXAMINATION
GENERAL PHYSICAL EXAMINATION
THYROIDSWELLINGTREMORSSKINEYE BROWS
NECK VEINSENGORGEMENT, PALSATIONS
GENERAL PHYSICAL EXAMINATION
Assess the Patient’s Jugular Venous Pressure
GENERAL PHYSICAL EXAMINATION
ASSESSMENT FOR DISTENTION OF THE RIGHT INTERNAL JUGULAR (I.J) VEIN
DETERMINING THE CVP(CENTRAL VENOUS PRESSURE)
GENERAL PHYSICAL EXAMINATION
GENERAL PHYSICAL EXAMINATION
BLOOD PRESSURE
GENERAL PHYSICAL EXAMINATION
ARTHRITTIS, RH. CHOREA, NODULES, RASH
RESPIRATION
GENERAL PHYSICAL EXAMINATION
GENERAL PHYSICAL EXAMINATION
ARCUS CORREALIS / SENALIS
XANTHOMAS / XANTHELASMA
A. INSPECTION1. SHAPE OF CHEST AND PRAECORDIUM2. NECK VEINS3. POSITION OF APEX BEAT4. VEINS – OF THE CHEST WALL5. OTHER PULSATIONS
- SUPRASTERNAL NOTCH- EPIGASTRIUM- RIGHT SECOND I.C.SPACE- LEFT SECOND I.C.SPACE
6. ANY SCAR, PIGMENTATION
EXAMINATION OF HEART
B. PALPATION1. POSITION AND CHARACTER OF APEX BEAT2. THRILL3. HEAVE4. ANY OTHER PULSATIONS
EXAMINATION OF HEART
PALPATION OF THE PRECORDIUM TO DETERMINE THE LOCATION OF THE PMI
PALPATION OF THE PRECORDIUM TO DETERMINE THE LOCATION OF THE PMI
PALPATE FOR ANY HEAVES OR THRILL
C. PERCUSSION FOR CARDIAC DULLNESS1. HYPERTROPHY OF HEART2. DILATATION OF HEART3. PERICARDIAL EFFUSION4. AORTIC ANEURYSM5. VENT. ANEURYSM6. EMPHYSEMA
EXAMINATION OF HEART
AUSCULTATION OF THE HEART
AUSCULTATION OF THE HEART
BAD EXAMINATION OPTIONS WHEN AUSCULTING MALE OR FEMALE PATIENTS
AUSCULTTION OF HEART
FURTHER CHECK FOR MITRAL STENOSIS
ASSESS FOR AORTIC INCOMPETENCE
AUSCULTATION
HEART SOUNDS1. INTENSITY OF HEART SOUNDS2. SPLITTING OF HEART SOUNDS
A) SPLITTING OF 1ST HEART SOUNDSB) SPLITTING OF 2ND H.S. (R.B.B.B., A.S.D., PUL. ST.)C) REVERSE SPLITTING OF 2ND HEART SOUNDS
(A.S., L.B.B.B., P.D.A., COARCTATION OF AORTA, H.O.C.M., L.V. DYSFUNCTION.)
EXAMINATION OF HEART
EXAMINATION OF HEART
AUSCULTATION3. TRIPLE RHYTHM (GALLOP RHYTHM)
a) III H.S. GALLOP (S3)b) IV H.S. GALLOP (S4)C) SUMMATION GALLOP
4. OPENING SNAP5. EJECTION CLICKS
EXAMINATION OF HEART
1. MURMURS2. PERICARDIAL RUB3. CARDIO-RESPIRATORY MURMURS4. VENUS HUM
ADDITIONAL SOUNDS
MURMURSORGANICBENIGN, INNOCENT, FUNCTIONALFEATURES
1. TIMING2. CHARACTER3. DISTRIBUTION4. RADIATION5. GRADING G1 G66. EFFECT OF RESP.7. EFFECT OF POSTURE8. EFFECT OF EXERCISE.
ADDITIONAL SOUNDS
EXAMINATION OF HEART
EXAMINATION OF HEART
THANK YOU
EXAMINATION OF CARDIOVASCULAR SYSTEM
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