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EXAMINATION OF CARDIOVASCULAR SYSTEM
SOME DEFINITIONS AND REVISION
•
1st degree AV block:
prolongation of AV conduction time
•
2nd degree AV block:
some, but not all atrial impulses fail to reach theventricles
•
3rd degree (complete) AV block:
all atrial impulses fail to reach ventricles
•
anatomy in femoral triangle:
○
femoral vein (medial(
○
femoral artery (the landmark (
○
femoral nerve (lateral(POSITION: patient lying in bed with enough pillows to support him at 45 degreesGENERAL APPEARANCE
•
general state of health? apparently ill?
•
rapid and laboured respiration?
•
cachectic
(severe loss of weight and muscle wasting)? (commonly caused bymalignant disease or severe cardiac failure [cardiac cachexia([
•
Marfan's syndrome
(tall stature, thoracic kyphosis, high arched palate, pectusexcavatum, long lims, arachnydactyly (spider fingers))? Marfan's syndrome isassociated with
aortic regurgitation
•
 Down's syndrome?
associated with congenital heart disease, especiallyendocardial cushion defects
•
Turner's syndrome?
associated with coarctation of the aortaHANDS AND FOREARM
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nails
○
clubbing - see Figure 3.3
def: increase in soft tissue of distal part of fingers or toes
for patient with clubbing examine finger nails - and determineif there is loss of angle between nail bed and finger 
causes of clubbing:
common
cardiovascular 
cyanotic congenital heart disease
infective endocarditis
respiratory
lung carcinoma (usually not small cellcarcinoma(
 
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chronic pulmonary suppuration:
 bronchiectasis
lung abscess
empyema
idiopathic pulmonary fibrosis
uncommon
respiratory
cystic fibrosis
asbestosis
 pleural mesothelioma (benign fibroustype) or pleural fibroma
gastrointestinal
cirrhosis (especially biliary cirrhosis(
inflammatory bowel disease
coeliac disease
thyrotoxicosis
familial or idiopathic
rare
neurogenic diaphragmatic tumours
 pregnancy
unilateral clubbing - bronchial arteriovenousaneurysm or axillary artery aneurysm
○
splinter haemorrhages - see Figure 3.4
def: linear haemorrhages lying parallel to long axis of nail
causes:
trauma
infective endocarditis
rare:
vasculitis as in rheymatoid arthritis
 polyarteritis nodosa
sepsis
haematological malignancy
 profound anaemia
•
 fingers
○
 Osler nodes
def: red, raised tender nodules on pulps of fingers (or toes) or thenar or hypothenar eminences
are a rare manifestation of infective endocarditis
•
 palms
 
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○
Janway lesions
def: non-tender erythematous maculopapular lesions containing bacteria which can occur on pulms of pulps of fingers
are a rare manifestation of infective endocarditis
•
 forearm
○
xanthomata - see Figure 3.5 and Figure 3.6
def: (yellow or orange) deposits of lipid in tendons
can occur in hyperlipidaemiaARTERIAL PULSE
•
following observations should be made for radial pulse:
○
rate of pulse
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rhythm
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 presence or absence of delay of femoral pulse comparied with radial  pulse (radiofemoral delay
(
•
character and volume are better assessed from palpation of brachial or carotid arteries
•
rate
of pulse
 
○
 bradycardia = pulse < 60 beats/min
causes of bradycardia:
regular rhythm
 physiological (athletes, sleep: due to increasedvagal tone(
drugs (e.g. beta blockers, digoxin, amiodarone(
hypothyroidism (decreased sympathetic activitysecondary to lack of TH(
hypothermia
 jaundice (in severe cases only, due to depositionof bilirubin in conducting system(
raised intracranial pressure (due to effect oncentral sympathetic outflow) - a late sign
third degree AV block or second degree AV block (type 2(
MI
 paroxysmal (
def:
sudden onset, usually withrecurrent manifestations) bradycardia:
vasovagal syncope
acute hypoxia or hypercapnia
acute hypertension
regularly irregular rhythm
 
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