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Cardiac History & Examination

Cardiac History & Examination. Jamil Mayet Consultant Cardiologist St Mary’s Hospital. Chest Pain. Character Radiation Relation with inspiration Provocation Grading Canadian Cardiovascular Society I - Ordinary activity does not provoke II - Slight limitation of ordinary activity

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Cardiac History & Examination

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  1. Cardiac History & Examination Jamil Mayet Consultant Cardiologist St Mary’s Hospital

  2. 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

  3. 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

  4. Other Symptoms • Palpitations • Regular / irregular • Fast / slow • Extra beats • Syncope • Usually sudden and brief if cardiac cause • “Stokes-Adams” attacks • Fatigue • Oedema

  5. 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

  6. Hands • Clubbing • Cyanotic Congenital Heart Disease • Bacterial Endocarditis • Peripheral stigmata of endocarditis • Splinter haemorrhages • Osler nodes • Janeway lesions • Peripheral cyanosis • Cardiac / Respiratory / Vasoconstriction

  7. Pulse • Radial • Rate • Rhythm • Volume • (Character)

  8. Pulse

  9. Blood Pressure Appropriate cuff size Palpate first Slowly deflate Korotkoff V

  10. Eyes and mouth • Anaemia • Jaundice • Xanthelesma • Corneal arcus • Central cyanosis

  11. Carotid pulse

  12. Jugular Venous Pressure

  13. 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

  14. 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

  15. Praecordium

  16. Praecordium

  17. Auscultation Apex LSE Pulm Aortic 1st sound 2nd sound Systole Diastole

  18. Auscultation Radiation of murmurs Left side with bell at apex Sat forward in expiration

  19. Murmurs • Systolic • Ejection • Aortic, (pulmonary), flow murmurs • Pan systolic • MR, (TR), (VSD) • Diastolic • Early • AR, (PR) • Mid • MS, (TS)

  20. Peripheral pulses

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