Examination of cardio vascular system

Common symptoms in cardio-vascular system

Angina Dyspnoea (At rest or on exertion?, orthopnea?, Paroxysmal Nocturnal Dyspnoea) Palpitation Edema Fatigue Syncope

RISK FACTORS
Smoking. Obesity Hypertension High fat Diet Physical activity or inactivity Occupation: sedentary or active, and how active? Stress levels; occupational and others.
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Angina
Angina is the temporary chest pain or a sensation of pressure that occurs when the heart muscle is not receiving enough oxygen Not everyone with ischemia experiences angina.ischemia without angina is called silent ischemia

Types of angina
Nocturnal angina that occurs at night during sleep Angina decubitus angina that occurs when the patient is lying down Variant angina angina at rest and not during exertion
Spasm of one of large coronary arteries on surface of heart

Unstable angina is a medical emergency.there exists a varied patterns of symptoms severe pain ,increased frequency of pain
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 Angina is felt as a pressure or ache beneath the sternum Either in shoulder or down the inside of either arm,through the back,in the throat,jaw,or teeth Pain is felt in back and shoulders misdiagnosed as arthritis Pain may occur in stomach area misdiagnosed as stomach ulcer

Examination of the heart

Inspection: of jugular venous pulse and point of maximal impulse Palpation: of point of maximum impulse and thrills Auscultation: for valve closing sounds (S1 and S2.

JUGULAR VENOUS PULSE

The jugular venous pulse lies behind the sternocleidomastoid muscle To measure the JVP, incline the patient to 3045 degrees and use tangential light. a jugular venous pulse more than 5 cm above the sternal angle is a sign of fluid overload or abnormal cardiac function,right sided heart disease
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PMI: POINT OF MAXIMUM IMPULSE

The point of maximal impulse (PMI) is the (sometimes) visible and (usually) palpable contraction of the left ventricle (LV) during systole It is usually located at the 5 th intercostal space in the left midclavicular line, an imaginary line down from the middle of the clavicle
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Pulse
Rhythm: The most common irregularities are atrial arrhythmias and extrasystoles (which may disappear on exertion) Character: water hammer - Thready, strong, bounding, collapsing seen in

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Pulse
'pulsus paradoxus' - A pulse that weakens in inspiration is called (as opposed to the normal increase in volume)
constrictive pericarditis pericardial effusion restrictive cardiomyopathy severe asthma.

'Pulsus alternans' - an alternate variation in size of pulse wave

is an important sign of left ventricular failure, but may be normal in the presence of a fast ventricular rate.

'Pulsus bigeminus': groups of two heartbeats close together followed by a longer pause. The second pulse is weaker than the first.
premature ventricular contractions after every other beat. hypertrophic obstructive cardiomyopathy

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AUSCULTATORY AREAS
aortic area or right sternal border (RSB) right 2nd intercostal space pulmonic area or left upper sternal border (LUSB) - left 2 nd intercostal space tricuspid area or left lower sternal border (LLSB) is at the left fourth intercostal space mitral area or apex is at the PMI -- the 5 th intercostal space in midclavicular line

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AUSCULTATION OF THE HEART

be sure to use both sides of the stethoscope to examine the heart the diaphragm is best for hearing high-pitched sounds, including S1, S2 and most heart murmurs the bell is bests for hearing low-pitched sounds, including S3, S4 and a few murmurs (e.g. mitral stenosis) use LIGHT TOUCH when using the bell. Pressure turns it into a diaphragm
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HEART SOUNDS
S1 closure of atrioventricular - mitral and tricuspid Valves S2 - closure of semilunar -- aortic and pulmonic valves S1 and S2 The Lub-dub sound of the heart is S1-S2.

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S1 sound
S1 is the sound made when the mitral and tricuspid (atrioventricular or AV) valves close. It marks the beginning of systole S1 is loudest at apex or left lower sternal border

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S2 sound
S2 is the sound made when the aortic and pulmonic (semilunar) valves close. It marks the beginning of diastole. S2 is loudest at the base. The top of the heart is the base.

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RHYTHM
Rhythm is usually regular. Healthy young people often have a sinus arrhythmia: their pulse is slower in expiration.

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HEART MURMURS
Heart murmurs are produced by turbulence Causes of heart murmurs include: increased blood flow across normal valves for example, in pregnancy or hyperthyroidism, or an innocent murmur), or turbulent flow through abnormal valves: tight valve (stenosis) or leaky valve (regurgitation or insufficiency)
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 HEART MURMURS: TIMING Systolic: between S1 and S2 (during systole) Diastolic: after S2

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COMMON SYSTOLIC MURMUR: MITRAL REGURGITATION

it is typically holosystolic -- heard throughout systole, often blurring S1 and S2 Mitral regurgitation murmurs are loudest at the apex and often radiate to the axilla

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COMMON SYSTOLIC MURMUR: AORTIC STENOSIS

they are diamond-shaped and have a harsher quality Aortic stenosis murmurs are most often loudest in the aortic area (RSB), though they may also be loudes in the tricuspid area (LLSB)

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COMMON SYSTOLIC MURMUR: MITRAL VALVE PROLAPSE

Mitral valve prolapse murmurs are heard best at the apex MVP murmur is classically a late systolic murmur preceded by one or more midsystolic clicks

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A COMMON DIASTOLIC MURMUR: AORTIC INSUFFICIENCY

It occurs early in diastole Aortic insufficiency murmur is loudest in the aortic or tricuspid area

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HEART MURMUR
Mitral stenosis Aortic regurgitation Mitral regurgitation Aortic stenosis Mid-diastolic murmur Diastolic murmur Holosystolic murmur Mid-systolic ejection murmur

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