Cardiovascular System

Abdullah Al-Kasasbeh , MD Jordan University of Science and Technology

Symptoms Of Cardiovascular Disease
A- Dyspnea
Exertional PND Orthopnea Grading ( NYHA Grading)

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-

Hemoptysis Ankle swelling Syncope Fatigue.

History Taking
 Identity

of the patient

 Chief

Complaint ( symptoms, occasionally signs)

 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:

1- Chronic maintenance 2- Current medications 3- Drug abuse 4- Drug allergy

 Family

History:

1- HOCM 2- Congenital long QT syndrome 3- Marfan syndrome 4- Hypertension, DM, hyperlipidemia, CAD

 Personal

and Social History:

1- Cigarette smoking 2- Alcohol ingestion 3- Housing 4- Income 5- Medical Insurance

Examination Of The Cardiovascular System
A- Inspection B- Palpation C- Auscultation

General Examination
 Face:

Dyspnea Cyanosis Pallor Xanthelasma Corneal arcus Malar flush

 Hands:

Cyanosis Clubbing Splinter hemorrhage Warm or cold

 Radial

Pulse:

Rate Rhythm Volume Character ( large arteries,i.e; carotid, brachial)

 Upper

Extremity Pulses delay

 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.

B.P Measurement Fundus Examination

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. )

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