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.

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

LOCATE THE APEX BEAT

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

MITRAL VALVE LOCATION

TRICUSPID VALVE LOCATION

PULMONARY VALVE LOCATION

AORTIC VALVE LOCATION

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

FEEL THE SACRUM FOR OEDEMA

ASSESS THE ANKLES FOR OEDEMA

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