Professional Documents
Culture Documents
B- Chest Pain
site, character, radiation, duration, associations, precipitating factors, relieving factors. Causes of chest pain: Angina Aortic dissection Pericardial pain Atypical ( musculoskeletal, esophageal pain, ulcer pain, pulmonary embolism, pneumothorax, cervical spine, etc.)
C- Palpitation
Definition, Causes.
DEFG-
History Taking
Identity
of the patient
Chief
History
1- Analysis of chief complaint 2- Associations of the chief complaint 3- Finish the system in presentation
Of Present Illness
Systemic
Review
Past
Medical History
1- Rheumatic fever 2- Hypertension 3- Diabetes Mellitus 4- Coronary artery disease 5- Congenital heart disease 6- Previous surgery, hospitalization, trauma.
Drug
History:
Family
History:
1- HOCM 2- Congenital long QT syndrome 3- Marfan syndrome 4- Hypertension, DM, hyperlipidemia, CAD
Personal
General Examination
Face:
Hands:
Radial
Pulse:
Upper
Radio-Femoral Neck
Examination:
Carotid JVP
Precordial Examination:
1- Inspection:
Skeletal Deformities Scars Dilated Collaterals Localised Precordial bulge Pulsations, Apex beat
2- Palpation
Apex beat Palpable thrills Left parasternal heave Pulmonary area First aortic area Left Infraclavicular area Epigastric area
3- Auscultation
Auscultate the following areas using both Diaphragm and Bell: Apex, Tricuspid area, Pulmonary area, 1st aortic area Auscaltate the apex in the Left lateral position using the Bell. Auscaltate the 2nd Aortic area in the sitting position using the Diaphragm. Listen to the Lung bases.
Legs:
Peripheral Pulses (femoral, popliteal, posterior tibial, dorsalis paedis ) Ankle edema Varicosities Calf ( DVT) Signs of peripheral arterial insufficiency.
Collapsing Pulse (Aortic regurgitation) Slow raising pulse: reduced peak ocurring late in systole (Aortic stenosis ) Bisferiens Pulse ( AR, combined AS and AR, and HOCM) Pulsus alternans Paradoxical pulse
Types Of Pulse
Heart Auscultation
A- Normal Heart Sounds
S1 S2 ( definitions and abnormalities )
B-Added Sounds
S3 S4 ( gallop rhythm) Clicks -ejection(aortic,Pulmonary) - Non ejection (MVP) Opening snap Pericardial rub
C-Murmurs:
Systolic ( mitral, aortic, pulmonary, tricuspid ) Diastolic ( mitral, aortic, pulmonary)
( Timing, Place of maximum intensity, radiation, pitch, maneuvers. )