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CardiovascularSystem
Abdullah Al-Kasasbeh , MD
Jordan University of Scienceand Technology
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Symptoms Of Cardiovascular
Disease
A- DyspneaExertional
PND
OrthopneaGrading ( NYHA Grading)
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B- Chest Pain site, character, radiation, duration,
associations, precipitating factors, relievingfactors.
Causes of chest pain:
AnginaAortic dissection
Pericardial pain
Atypical ( musculoskeletal, esophagealpain, ulcer pain, pulmonary embolism,pneumothorax, cervical spine, etc.)
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C- PalpitationDefinition, Causes.
D- Hemoptysis
E- Ankle swellingF- Syncope
G- Fatigue.
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History Taking
Identity of the patient
Chief Complaint ( symptoms,
occasionally signs)
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History Of Present Illness1- Analysis of chief complaint2- Associations of the chief
complaint3- Finish the system inpresentation
Systemic Review
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Past Medical History
1- Rheumatic fever2- Hypertension
3- Diabetes Mellitus4- Coronary artery disease
5- Congenital heart disease
6- Previous surgery, hospitalization,trauma.
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Drug History:
1- Chronic maintenance2- Current medications
3- Drug abuse
4- Drug allergy
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Family History:
1- HOCM2- Congenital long QT syndrome
3- Marfan syndrome
4- Hypertension, DM, hyperlipidemia,CAD
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Personal and Social History:
1- Cigarette smoking
2- Alcohol ingestion3- Housing
4- Income
5- Medical Insurance
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Examination Of TheCardiovascular System
A- InspectionB- Palpation
C- Auscultation
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General Examination
Face:DyspneaCyanosisPallorXanthelasma
Corneal arcusMalar flush
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Hands:
Cyanosis
Clubbing
Splinter hemorrhageWarm or cold
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Radial Pulse:Rate
RhythmVolume
Character ( large arteries,i.e;carotid, brachial)
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Upper Extremity Pulses
Radio-Femoral delay
Neck Examination:
Carotid
JVP
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Precordial Examination:
1- Inspection:
Skeletal DeformitiesScarsDilated Collaterals
Localised Precordial bulgePulsations, Apex beat
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2- Palpation
Apex beat
Palpable thrills
Left parasternal heavePulmonary area
First aortic area
Left Infraclavicular area
Epigastric area
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3- Auscultation Auscultate the following areas
using both Diaphragm and Bell:Apex, Tricuspid area, Pulmonaryarea, 1st aortic area
Auscaltate the apex in the Leftlateral position using the Bell.
Auscaltate the 2nd Aortic area in
the sitting position using theDiaphragm.
Listen to the Lung bases.
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Legs: Peripheral Pulses (femoral, popliteal,
posterior tibial, dorsalis paedis )
Ankle edema Varicosities
Calf ( DVT)
Signs of peripheral arterialinsufficiency.
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B.P Measurement
Fundus Examination
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Types Of Pulse
Collapsing Pulse (Aorticregurgitation) Slow raising pulse: reduced peak
ocurring late in systole (Aorticstenosis ) Bisferiens Pulse ( AR, combined AS
and AR, and HOCM) Pulsus alternans Paradoxical pulse
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Heart Auscultation
A- Normal Heart Sounds
S1 S2
( definitions and abnormalities )
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B-Added Sounds
S3 S4 ( gallop rhythm)
Clicks -ejection(aortic,Pulmonary)- Non ejection (MVP)
Opening snap
Pericardial rub
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C-Murmurs:
Systolic ( mitral, aortic, pulmonary,tricuspid )
Diastolic ( mitral, aortic, pulmonary)
( Timing, Place of maximum intensity,radiation, pitch, maneuvers. )
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