• APROACH TO THE

CARDIOVASCULAR PATIENT
• SYMPTOMS
 THREE POSIBILITIES
• CHEST PAIN
• DISPNOEA
• PALPITATIONS
• PAIN
Fig.1. Cardiovascular Causes of Chest Pain
Fig. 2. Diferential diagnosis of chest pain
Fig.3. Chest pain diagnosis algorithm
• DISPNOEA
Fig.4
Fig. 5
Fig.6. Dispnea
diagnosis algorithm
• PALPITATIONS
Fig.7. Diagnostic approach to the patient with palpitations
Fig.8.
Chest pain Dyspnea Palpitations

Rest ECG EcoDoppler, Rest ECG

Chest x-Ray

Stress ECG Holter ECG

± Holter ECG Natriuretic
peptides

Coronarography Electrophysiology
Effort test
(NYHA class)

Fig. 9 . Diagnosis algorithm in CV disease

• SIGNS
 Fig. 10. Eruptive xanthomas on the elbow
Fig.11. Telangiectasia of the mouth and cheek (Osler-Weber-Rendu disease)
Fig.12. Nail clubbing (right) and a normal nail (left)
Fig.13. The basic heart sounds consist of the first heart sound (S1), the
second heart sound (S2), the third heart sound (S3), and the fourth heart
sound (S4).
Fig.14
Fig. 15. Splitting of the 2nd cardiac sound
Fig.16. Pathologic sound III –ventricular gallop
Fig.17. Pathologic sound IV – atrial gallop
Fig.18. Summation gallop
Fig.19. Protosystolic click
Fig.20.
Mesosystolic clicks
 64 curs

Fig.21. The opening snaps

 51 curs

Fig.22. Ejection systolic murmurs

Fig.23. Ejection systolic murmurs
Fig.24. Regurgitation systolic murmurus
Fig.25. Diastolic filing murmurs
 57 curs

Fig.26. Diastolic murmurs

 59 curs

Fig.27. Double murmurs

Fig.28. Continuous murmurs
Fig.29
• LABORATORY EXAMINATION
• BIOCHEMICAL DATA
Fig.30. Normal ECG
Fig.31. Paroxysmal supraventricular tachycardia
Fig.32. Atrial flutter
 EKG

Fig.33. Ventricular extrasystoles

Fig.34. Ventricular tachycardia
Fig.35. Acute ST elevation myocardial infarction
Fig.36. Echo M of the mitral valve. Mitral valve prolapse
Fig. 37. Echo 2D. Four chambers view
Fig.38. Color flow imaging. Aortic regurgitation
Fig.39. Color flow imaging. Mitral regurgitation
 Aortic and LV enlargement.
Fig.40. Chest x-Ray
Severe pulmonary congestion.
Acute pulmonary edema
 Aortic regurgitation.
Fig.41.Chest x-Ray
LV hypertrophy.
Ascending aorta enlargement.
Pulmonary congestion
Fig.42. Exercise stress testing.

A. Rest ECG

B. Exercise ECG
ST depression > 1 mm.
Positive ET
 Fig.43. Holter ECG monitoring

Ventricular tachycardia. Torsade de pointe.

Fig.44. Coronarography. Severe coronary stenosis
Fig.45. Normal coronarography
Fig.46. Computed tomography.
Visualization of a normal aortic valve in open (A) and closed (B) positions
Fig. 47. Computed tomography.
High-grade right coronary artery stenosis (arrows)
Fig.48. Magnetic resonance imaging

Left panel - Left coronary artery and branches (dotted arrows).

Right panel - Right coronary artery (RCA).