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How to Examine the Heart

How to Examine the Heart

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How to Examine the Heart

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  1. How to Examine the Heart Introduction and Inspection

  2. How to Examine the Heart • Examine the heart from peripheral to central putting the pieces of the puzzle together as you go • By the time you put the stethoscope on the chest you should know what you will hear • Don’t leave the bedside and then try to figure out what you’ve heard. Be certain before the exam is over.

  3. Inspection Look for clues to the diagnosis

  4. Inspection • Go with the probabilities • Long thin people have long thin valves (MVP) • Males more likely to have aortic valve disease • Young-think bicuspid aortic valve • Middle age-think rheumatic AV disease • Elderly -think degenerative AV disease • Females- think mitral valve disease • MVP much more common than rheumatic MV disease

  5. Down syndrome trisomy 21 VSD Turner syndrome – Partialdeletion or absence of X chromosome gonadal dysgenesis aortic coarctation bicuspid aortic valve aortic dissection Noonan’s syndrome Dysmophic feature-short stature,webbed neck Pulmonary stenosis Hypertrophic cardiomyopathy Marfan syndrome Myotonic Dystrophy Inspection Identify specific syndromes

  6. MARFAN Syndromehttp://www.io.com/~cortese/marfan/photographs used with permission Body Habitus • Tall/thin/long facies • Long fingers • Thumb sign • Wrist sign • Ligamentous laxity • Scoliosis/kyphosis • Pectus excavatum/carinatum • Ectopia lentis • Narrow long facies • High arched palate

  7. Habitus Tall/thin/long facies Long fingers Thumb sign Wrist sign Ligamentous laxity Scoliosis/kyphosis Pectus excavatum/carinatum Ectopia lentis Aortic dissection Dilatation of the aorta affecting sinuses of valsalva MVP Mitral regurgitation LV dilatation Dilated pulmonary artery < age 40 MAC < age 40 Marfan’s Syndrome

  8. Long fingersLigamentous laxity

  9. Ectopia Lentis in Marfan Syndrome

  10. Myotonic Dystrophy • Autosomal dominant /variable penetrance • Myotonia • Wasting /weakness facial and distal muscles • Frontal balding • Cataracts • Cardiomyopathy • Conduction defects • Low intelligence or dementia

  11. Inspection • Clubbing • Cyanosis • Xanthoma and xanthelasma • Arcus • Pectus excavatum

  12. Differential Diagnosis of Clubbing • Cyanotic congenital heart disease • Lung disease • Cystic fibrosis • Interstitial fibrosis • Malignancy • Sarcoidosis • Bronchiectasis • Hyperthyroidism

  13. Arcus senilis (juvenilis) Arcus juvenilis. This ring is associated with premature atherosclerosis

  14. Xanthelasma

  15. Xanthoma • Nodular protuberance of the extensor surface of the leg (left panel) as well as multiple nodules of the arm (right panel)

  16. Eruptive xanthoma • Bulbous cutaneouseruptions associated with hyperlipidemia

  17. Pigmentation due to amiodarone