7/30/2019 Cardiovascular System Sx Hx

1/38

7/30/2019 Cardiovascular System Sx Hx

2/38

7/30/2019 Cardiovascular System Sx Hx

3/38

CardiovascularSystem

Abdullah Al-Kasasbeh , MD

Jordan University of Scienceand Technology

7/30/2019 Cardiovascular System Sx Hx

4/38

Symptoms Of Cardiovascular

Disease

A- DyspneaExertional

PND

OrthopneaGrading ( NYHA Grading)

7/30/2019 Cardiovascular System Sx Hx

5/38

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.)

7/30/2019 Cardiovascular System Sx Hx

6/38

C- PalpitationDefinition, Causes.

D- Hemoptysis

E- Ankle swellingF- Syncope

G- Fatigue.

7/30/2019 Cardiovascular System Sx Hx

7/38

History Taking

Identity of the patient

Chief Complaint ( symptoms,

occasionally signs)

7/30/2019 Cardiovascular System Sx Hx

8/38

History Of Present Illness1- Analysis of chief complaint2- Associations of the chief

complaint3- Finish the system inpresentation

Systemic Review

7/30/2019 Cardiovascular System Sx Hx

9/38

Past Medical History

1- Rheumatic fever2- Hypertension

3- Diabetes Mellitus4- Coronary artery disease

5- Congenital heart disease

6- Previous surgery, hospitalization,trauma.

7/30/2019 Cardiovascular System Sx Hx

10/38

Drug History:

1- Chronic maintenance2- Current medications

3- Drug abuse

4- Drug allergy

7/30/2019 Cardiovascular System Sx Hx

11/38

Family History:

1- HOCM2- Congenital long QT syndrome

3- Marfan syndrome

4- Hypertension, DM, hyperlipidemia,CAD

7/30/2019 Cardiovascular System Sx Hx

12/38

Personal and Social History:

1- Cigarette smoking

2- Alcohol ingestion3- Housing

4- Income

5- Medical Insurance

7/30/2019 Cardiovascular System Sx Hx

13/38

Examination Of TheCardiovascular System

A- InspectionB- Palpation

C- Auscultation

7/30/2019 Cardiovascular System Sx Hx

14/38

General Examination

Face:DyspneaCyanosisPallorXanthelasma

Corneal arcusMalar flush

7/30/2019 Cardiovascular System Sx Hx

15/38

7/30/2019 Cardiovascular System Sx Hx

16/38

Hands:

Cyanosis

Clubbing

Splinter hemorrhageWarm or cold

7/30/2019 Cardiovascular System Sx Hx

17/38

7/30/2019 Cardiovascular System Sx Hx

18/38

Radial Pulse:Rate

RhythmVolume

Character ( large arteries,i.e;carotid, brachial)

7/30/2019 Cardiovascular System Sx Hx

19/38

Upper Extremity Pulses

Radio-Femoral delay

Neck Examination:

Carotid

JVP

7/30/2019 Cardiovascular System Sx Hx

20/38

7/30/2019 Cardiovascular System Sx Hx

21/38

7/30/2019 Cardiovascular System Sx Hx

22/38

7/30/2019 Cardiovascular System Sx Hx

23/38

Precordial Examination:

1- Inspection:

Skeletal DeformitiesScarsDilated Collaterals

Localised Precordial bulgePulsations, Apex beat

7/30/2019 Cardiovascular System Sx Hx

24/38

2- Palpation

Apex beat

Palpable thrills

Left parasternal heavePulmonary area

First aortic area

Left Infraclavicular area

Epigastric area

7/30/2019 Cardiovascular System Sx Hx

25/38

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.

7/30/2019 Cardiovascular System Sx Hx

26/38

7/30/2019 Cardiovascular System Sx Hx

27/38

7/30/2019 Cardiovascular System Sx Hx

28/38

Legs: Peripheral Pulses (femoral, popliteal,

posterior tibial, dorsalis paedis )

Ankle edema Varicosities

Calf ( DVT)

Signs of peripheral arterialinsufficiency.

7/30/2019 Cardiovascular System Sx Hx

29/38

B.P Measurement

Fundus Examination

7/30/2019 Cardiovascular System Sx Hx

30/38

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

7/30/2019 Cardiovascular System Sx Hx

31/38

Heart Auscultation

A- Normal Heart Sounds

S1 S2

( definitions and abnormalities )

7/30/2019 Cardiovascular System Sx Hx

32/38

7/30/2019 Cardiovascular System Sx Hx

33/38

7/30/2019 Cardiovascular System Sx Hx

34/38

7/30/2019 Cardiovascular System Sx Hx

35/38

B-Added Sounds

S3 S4 ( gallop rhythm)

Clicks -ejection(aortic,Pulmonary)- Non ejection (MVP)

Opening snap

Pericardial rub

7/30/2019 Cardiovascular System Sx Hx

36/38

7/30/2019 Cardiovascular System Sx Hx

37/38

C-Murmurs:

Systolic ( mitral, aortic, pulmonary,tricuspid )

Diastolic ( mitral, aortic, pulmonary)

( Timing, Place of maximum intensity,radiation, pitch, maneuvers. )

7/30/2019 Cardiovascular System Sx Hx

38/38