Cardiovascular

system
MBChB III
KeMU
Nov

Einstein MD -3rd year MBChB

What are the symptoms
associated with CVS

Einstein MD -3rd year MBChB

 History
O Chest pain
O Ischemia
O Pericarditis
O Dissection of aorta
O Breathlessness/dyspnea
O An abnormal awareness of breathing
O Exertional dyspnea
O Orthopnea
O Paroxysmal Nocturnal dyspnea
O Fatigue
O Tiredness/weakness
O Deconditioning and muscular atrophy
O Inadequate oxygen supply to muscle, decreased CO

Einstein MD -3rd year MBChB

 History
O Palpitation
O Awareness of heart beat
O Cardiac rhythm abnormality
O Rate and rhythm description
O Dizziness and syncope
O Transient hypotension/ cerebral hypoperfusion

Einstein MD -3rd year MBChB

The examination
Part two

Einstein MD -3rd year MBChB

 Inspection
O Appearance of chest wall
O Chest wall deformities
O Visible pulsations
O Venous collaterals
O Anemia, pallor
O Cyanosis
O Peripheral
O Central
O Clubbing of fingers
O Congenital cyanotic
O Infective endocarditis

Einstein MD -3rd year MBChB

 Inspection
O Others
O Vasculitic rash
O Erythema marginatum
O Splinter hemorrhages
O Osler’s nodes
O Janeway lesions;
O Roth spots
O Cold peripheries
O Edema
O Fever

Einstein MD -3rd year MBChB

 Finger clubbing

Einstein MD -3rd year MBChB

 Osler’s node

Einstein MD -3rd year MBChB

 Splinter hemorrhages

Einstein MD -3rd year MBChB

 Janeway lesion

Einstein MD -3rd year MBChB

 Erythema marginatum

Einstein MD -3rd year MBChB

 Finger clubbing

Einstein MD -3rd year MBChB

 JVP

Einstein MD -3rd year MBChB

 Inspection
O Arterial pulse
O Rate
O Rhythm
O Character.
O Slow rising
O collapsing
O Biphasic
O Alternating
O Paradoxical pulse
O Symmetry
O Jugular venous pressure
O Blood pressure
O Supine
O Erect

Einstein MD -3rd year MBChB

 Inspection
O Blood pressure
O Phase 1: the first appearance of the sounds
marking systolic pressure
O Phase 2 and 3: increasingly loud sounds
O Phase 4: abrupt muffling of the sounds
O Phase 5: disappearance of the sounds

Einstein MD -3rd year MBChB

 Facial signs in cvs
Facial sign Description Possible cardiac association
Malar flush Redness around the cheeks Mitral stenosis

Xanthomata Yellowish deposits of lipid Hyperlipidemia

around the eyes, palms, or
tendons

Corneal arcus A ring around the cornea Age, hyperlipidemia

Proptosis Forward projection or Atrial fibrillation

displacement of the eyeball;
occurs in patients with
Graves' disease

Einstein MD -3rd year MBChB

 Palpation
O Apex beat
O Lowest and most lateral point at which the
cardiac impulse can be palpated
O Heaving
O Tapping
O Parasternal thrust of RVH
O Thrills

Einstein MD -3rd year MBChB

 Auscultation
O Heart sounds
O Diaphragm and bell for high and low pitched sounds respectively
O Mitral , tricuspid, pulmonary and aortic areas
O S1 and S2
O 3rd and 4th sounds
O Heart murmurs
O Systolic
O Diastolic
O Intensity
O Location
O Radiation

Einstein MD -3rd year MBChB

 Auscultation
O Intensity/grade of murmurs
1. Barely audible, careful auscultation
2. Audible
3. Readily audible
4. Associated with a thrill
5. Readily audible rim of stethoscope lightly
touching chest wall
6. Audible without a stethoscope

Einstein MD -3rd year MBChB

 Timing and duration of murmur
O Early, mid or late-systolic or diastolic
O Pansystolic -beginning of S1 to the end of S2
O Holosystolic- end of S1 to the beginning of S2
O Holodiastolic end of S2 to the beginning of
S1).
O Presystolic-between the A sound and S1).

Einstein MD -3rd year MBChB

 Auscultation
O Friction rubs
O Venous hums

Einstein MD -3rd year MBChB

 Reference
O Hutchison’s clinical methods. 22nd Edition
O Cardiology Explained. Euan A Ashley and
Josef Niebauer
O Pictures.
O UCSD
O Heathzene.com
O Lung India. 2012
O Medscape

Einstein MD -3rd year MBChB