Anamnesis

Palpitations.
Most normal people can feel the increased activity of the heart when there is physical or
emotional stress. Palpitations can occur without serious heart disease for example, when anxiety,
but can also occur in potentially life-threatening condition. If complaints of palpitations occur
without strenuous physical activity then must find another cause, such as the presence of heart
failure, anemia, thyrotoxicosis and atrial fibrillation. The frequency of the pulse is irregular
impressive atrial fibrillation, the rapid frequency of more than 150 times per minute the
impressive presence of supraventricular tachycardia.
Syncope.
Syncope is a temporary loss of consciousness due to lack of blood perfusion to the brain. In
patients with syncope, a few things that should be evaluated:
-

Syncope prodromal symptoms (nausea, vomiting, chills, diaphoresis, dizziness, visual

change)
The patient's condition when syncope commonly asked of witnesses (duration syncope)
The patient's condition after the unconscious (muscle pain, incontinence, sweating,
paleness, vomiting)
Environment or condition that contribute to the onset of syncope (lying or standing
position, activity)

Previous disease history, is a history of previous syncope, heart disease, neurological or

metabolic, drugs are drunk, family history of sudden death due to heart disease.

Physical examination
Check the general appearance including ascites, obesity, cachexia (muscle wasting), anemia, and
other disorders. Shortness of breath existing value.
Hand
Tremor; peripheral cyanosis; pulsation capillary nail bed (Quincke's sign; aortic regurgitation,
tritoksitosis); splinter hemorrhage beneath the nail bed (trauma, endocarditis, inactivated):
clubbing
Face and Neck
Check the conjunctiva for anemia; tongue (lip) for central cyanosis; eyelid to xanthelasma; retina
for damage caused by hypertension. Check the enlarged lymph nodes or the thyroid, and signs of
systemic illness.
Abdomen

Palpation enlargement or tenderness of the liver (hepatomegaly), ascites (increased CVP, heart
failure), splenomegaly (infective endocarditis)
Lower extremity, ankle edema Rate and signs of peripheral vascular disease.
Pulse
When the resting heart rate is 60-90 beats / minute, slow down with age and in athletes.
Tachycardia if the frequency above 100 beats per minute, bradycardia if the frequency is below
60 times per minute. Compare with the throbbing pulse in the radial apex (delay) such as atrial
fibrillation) and femoral / lower extremities (delay) atherosclerosis, aortic stenosis). Changes in
heart rate when breathing is normal (sinus Aritma).

heartbeat irregular: eg in extrasystoles (disappears when the activity), cardiac blockade

degree two.Irregularly irregular: eg atrial fibrillation (pulse does not change with the
activity, there is a deficit pulsus), atrioventricular block (not all stimuli from the SA node
forwarded to ventricular ventricles so as not to contract. Usually there are bradikardi
under these conditions).
Character (carotid) corrugated (thready) or weak: heart failure, shock, valve disease; with
a slow increase: aortic stenosis. Strong / stomping (bounding): high rainfall followed by a
sharp decline (collapse water hammer): high rainfall; aortic valve regurgitation. Fickle
weak / strong (pulsus alternans): left heart failure; pulsus distinguished bigeminus,
normal beats followed by a premature beats weak. Pulsus paradoxus, a clear pulse
weakened as inspiration: cardiac tamponade, severe asthma, restrictive pericarditis.

Blood pressure
When resting, normal adult arterial systolic pressure <150 mmHg, diastolic BP <90 mmHg.
Systolic increases with age. Systolic can increase due to anxiety (white coat syndrome).

Jugular Venous Pressure (JVP) right atrial pressure measurements indirectly. JVP is
increased in heart failure and volume overload. Wave 'a' great: pulmonary hypertension,
pulmonary valve stenosis, tricuspid stenosis; V wave big: tricuspid regurgitation. There is
no 'a': atrial fibrillation.

Chest examination
Position the patient comfortably in bed with a chest forming an angle of 45 o. Check their surgical
scars, and deformity (eg, barrel shape).
Palpation; apex pulse , usually at the fifth intercostal space , line midclvicular (mitral area).
Disappear: obesity, hyperinflation, pleural effusion. Displaced: cardiomegaly, pneumothorax.
Tapping (jerking): mitral stenosis. Doubles: ventricular hypertrophy. Heaving (very strong and
stable): excess pressure-hypertension, aortic stenosis. Parasternal heave: right ventricular
hypertrophy. Thrill is a palpable murmur (because it is strong)

 Auscultation, Associated with a pulse. The first heart sound (S1): The closure of the mitral
valve (M1) and Tricuspid (T1). Toned: AV valve stenosis, internal PR shortened; soft: mitral
regurgitation, PR length, heart failure. The second heart sound (S2): aortic valve closure (A2)
and pulmonary (P2), A2 firmer and precedes P2. A2 / P2 tight: systemic hypertension /
pulmonary. Splitting: normal during inspiration or sports, especially in young people. Splitting
width: pending activation (eg right bundle branch block) or termination (pulmonary
hypertension, stenosis) RV systole. Splitting the upside: pending activation (eg, left bundle
branch block) or termination (hypertension, aortic stenosis) LV systole. Other: S3- rapid
ventricular filling, common in young people, but can reflect heart failure in patients> 30 years.
S4- precedes S1, due to ventricular stiffness and abnormal filling during atrial systole. Their S3
and / or S4 provides a gallop rhythm. Click ejection: after S1, AV stenotic valve opening. Mitral
sound is best heard when lying on the left side.
Due to the turbulent flow murmurs. Soft systolic murmur is common and does not mean
anything to young people (40% of children aged 3-8 years) and current physical exercise; all
diastolic murmur pathological. Most dangerous murmur caused by a defect in the valve. Others
included the ventricles. Vascular murmur (bruit) can indicate stenosis, such as in the carotid,
abdominal (aorta, radial artery).

Additional Examination
Rontgen (chest radiography)
In diafragmatis main structure where large abnormalities can be detected, for example,
enlargement of cardiac cavities and major vessels, as well as normal CXR PA. The size of the
heart and cardiothoracic ratio (heart size relative to the thorax) can also be expected. This ratio is
normally <50%, except in neonates, infants, and athletes, but it can be greatly increased in heart
failure.
Echocardiography and Doppler ultrasound
echocardiography can be used to detect an enlarged heart and abnormal heart movement, as well
as to estimate the ejection fraction. An ultrasound pulse of 2.5 MHz generated by a piezoelectric
transmitter-receiver on the chest wall, and reflected back by the internal structure. The Doppler
effect can be used to calculate the speed (velocity) of the blood movement on the pulse of
ultrasound frequency shift caused by the reflection of red blood cells, and the pressure gradient
that passes through the obstructive Bernouli equation: P = 4 x (velocity) 2. Blood flow can
counted when a cross-sectional area of blood were estimated using echocardiography
Catheterization and Angiography
Radiopaque catheter (opaque to x-rays) is inserted into the heart or blood vessels through a
peripheral vein or artery. The catheter is a small balloon at the tip premises (Swan-Ganz catheter)

assist the placement of the vein with the tip moving with the current. Catheter placement can be
ascertained from waveform pressure and chest X-ray.
Angiography radiopaque contrast medium is inserted into the lumen of the cardiac cavities and
other vessels. This enables direct visualization of blood vessels by X-rays, and can be used to
check the pump function jatung and determine the location of the blockage (eg embolism) in the
arrangement of blood vessels.
Imaging
Nuclear imaging radiopharmaceutical is inserted into the heart or circulation is detected by a
gamma camera, and distribution (depending on type) can be used to measure or detect perfusion,
damage, and heart muscle function.
Magnetic Resonance Imaging (MRI)
MRI is useful for mennentukan location of the mass and malformations, including aneurysms.
This examination is non-invasive and uses no radiation damage.