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How to Examine the Heart. Introduction and Inspection. 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

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how to examine the heart

How to Examine the Heart

Introduction and Inspection

how to examine the heart2
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.
inspection

Inspection

Look for clues to the diagnosis

inspection4
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
inspection identify specific syndromes
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
marfan syndrome http www io com cortese marfan photographs used with permission
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
marfan s syndrome
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
myotonic dystrophy
Myotonic Dystrophy
  • Autosomal dominant /variable penetrance
  • Myotonia
  • Wasting /weakness facial and distal muscles
  • Frontal balding
  • Cataracts
  • Cardiomyopathy
  • Conduction defects
  • Low intelligence or dementia
inspection11
Inspection
  • Clubbing
  • Cyanosis
  • Xanthoma and xanthelasma
  • Arcus
  • Pectus excavatum
differential diagnosis of clubbing
Differential Diagnosis of Clubbing
  • Cyanotic congenital heart disease
  • Lung disease
    • Cystic fibrosis
    • Interstitial fibrosis
    • Malignancy
    • Sarcoidosis
    • Bronchiectasis
  • Hyperthyroidism
arcus senilis juvenilis
Arcus senilis (juvenilis)

Arcus juvenilis. This ring is associated with premature atherosclerosis

xanthoma
Xanthoma
  • Nodular protuberance of the extensor surface of the leg (left panel) as well as multiple nodules of the arm (right panel)
eruptive xanthoma
Eruptive xanthoma
  • Bulbous cutaneouseruptions associated with hyperlipidemia