1 / 27

History taking and physical examination in Cardiovascular system.

History taking and physical examination in Cardiovascular system. Akintunde A.A Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria. History taking. Involves the obtainment of information from patients about their case A narrative work! A detective work!

blodwyn
Download Presentation

History taking and physical examination in Cardiovascular system.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. History taking and physical examination in Cardiovascular system. Akintunde A.A Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.

  2. History taking • Involves the obtainment of information from patients about their case • A narrative work! • A detective work! • Like Sherlock Holmes, Not like Eugenia Abu! • Logical interpretation of clinical history • Antecedent risk factor

  3. Precipitants • Complications • Prognosis

  4. Core Component of History taking • Biodata • Name • Age • Occupation • Gender • Religion • Residence • Tribe

  5. History of presenting complaints • Which system does this refer to? • Highlight in order of occurrence

  6. Main complaints • Common complaints • Pain • Fever • LOC

  7. History of presenting illness • History of symptom • History of aetiology • History of treatment • History of complication

  8. When was the patient last quite well? • Mode of onset of disease • Define disease progression • Desribe main presentation fully • Chronology of symptom • Pertinent negatives

  9. Past medical history • Developmental and antenatal history • Drug history • O&G History • Family and Social history

  10. Systemi review of systems • CVS • Chest • Abbdomen • Genito-urinary • Musculoskeletal • Neurological

  11. Clinical Summary • Short • Straight to d point! • Important negatives • Enough to make a differential diagnosis.

  12. Cardiovascular system Examination • Arterial pulse • Locomotorbrachialis • Blood pressure • Jugular venous pressure • Precordium

  13. Leftventricular output- radial pulse • JVP- right atrial pressure • Position • Exposure • Be calm • Take permission! • Be articulate!

  14. CVS examination • Inspect quickly • Position in bed • Dyspnoea • Orthopnoea • Cyanosis • Neck pulsation • Proptosis • Fluffy hair • Hyperpigmentation • Cahexia • gynaecomastia

  15. Arterial Pulse • Rate • Rhythm • Volume • Characetristics • Vessel wall • Sychronicity

  16. Radiofemoral delay • Peripheral pulse • Pulse deficit

  17. Blood pressure check! • Standard ways to measure BP • Interpretation • Thigh BP popliteal systolic BP>brachial BP 60mmHg, Hill’s sign - Aortic regurgitation • JNC VII • WHO • ESC • AHA • Nigerian Hypertension Society • Forum for the prevention of Hypertension in Africa

  18. Causes of • Tachycardia • Bradycarda • Irregularly irregular pulse • Pulsusalternans • Pulsustardus et parvus • Pulse deficit

  19. Jugular venous pressure • Differentiate JVP from carotid pulsation • Hepatojugular reflux • Measure JVP in metres • Assess wave forms a,c and v waves • Canon a waves • Kussmauls sign –paradoxical inspiratory rise in JVP (Venous pulsusparadoxus) seen in EMF, pericardial effusion, cardiac tamponade

  20. A controversy!! But important……. • Trachea shift!!

  21. Precordium • Inspect • Palpate • Percussion( only when u suspect Pericardial effusion • Auscultation

  22. Heart sounds • S1,2,3,4 • Loud S1- hyperdynamic circulation, mitral stenosis, • Soft S1-MR • Variable intensity in complete heart block • Any added sound? Click or murmur?

  23. Murmur • Murmur- timing? • Area of maximum intensity • Grading • Configuration-diamond shaped, decrescendo, holosystolic, systolic click murmur • Respiratory variation • Right sided murmur increase on inspiration • Left sided murmur increase on expiration • conductivity

  24. Aortic area- loud A2 HTN • Decrescendo diastolic murmur in aortic area – AR • Pulmonary area • Loud P2 • Splitting of P2, exagerated, reversed, fixed. • Neck- carotid bruits • Back basal lung crackles • Ewart sign-presence of bronchial signat posterior lung base due to compression of bronchi by large cardiomegaly or PE.

  25. Liver palpation- hepatomegaly, pulsatile?, ascites, • Legs- pedal oedema

  26. Further examination • Fundoscopy • Kidneys-APKD • Renal bruits

  27. Functional classification of severity of heart disease • NYHA/CCS • I • II • III • IV

More Related