Descending Tracts
CVS Exam
History
PC
• CP
• SOB:
o Orthopnoea
o PND
• Ankle swelling
• Palpatations/dizziness/blackouts
• Exercise tolerance
PMH
• Angina or MI
• RF
• Intermittent claudication
RFs
• Smoke
• HT
• DM
• Hyperlipidaemia
• FH
Examination
Hands
• Clubbing:
o Endocarditis
o Congen cyanotic heart disease
• Splinter haemorrhages ≈ infective endocarditis
• Oslers nodes ≈ infective endocarditis
• Janeway lesions (red macules on palms) ≈ infective endocarditis
• Nail fold infarcts ≈ vasculitis
• Tendon xanthomata ≈ hyperlipidaemia
BP
• Pulse pressure:
o Narrowed ≈ aortic stenosis
o Widened ≈ aortic regurgitation
• If HT examine:
o Fundi – HT damage
o Renal – did urine for proteinuria
o LVH signs: diffused apex beat
Face
• Cornael arcus or xanthelasma ≈ Hyperlipidaemia
• Malar flush ≈ mitral stenosis
• Bulging eyes ≈ Graves
Praecordium
• Palpate apex beat:
o Displacded lat ≈ LVH
o Heaving ≈ mitral or aortic regurg
o Thrusting ≈ aortic stenosis
o Taping ≈ mitral stenosis
o Diffuse ≈ LV failure, dilated cardiomyopathy
o Double impulse ≈ HOCM
• Feel for left parasternal heave ≈
o Pulmon stenosis
o Cor pulmonale
o ASD
• Thrills ≈ murmurs
Abdo
• Hepatomegaly and ascites may occur in right heart failure
• Splenomegaly may in endocarditis
Pulses
• Feel
o radio-fem delay ≈ coarctation
o radio-radio delay ≈ aortic arch aneurysm
• character & volume:
o bounding ≈
▪ CO2 retention
▪ Liver failure
▪ Sepsis
o Small volume ≈
▪ Aortic stenosis
▪ Shock
▪ Pericardial effusion
o Collapsing ≈
▪ Aortic incompitence
▪ PDA
o Slow rising ≈ aortic stenosis
o
Auscultation
• sit upright
• listen at all heart valves positions
↳ use bell over apex
• also listen in:
o left axilla – mitral incompetence
o carotids – aortic stenosis
• reposition pt into left side lie:
o feel apex beat again:
▪ ?tapping ≈ mitral stenosis
▪ ?diastolic rumble ≈ mitral stenosis
• reposition pt up & listen lower left sternal edge:
o breath in
o breath out and hold ( blowing diastolic sound of aortic regurg at end expiration
-----------------------
New York Heart Classification:
I = No SOB
II = SOB on mod exercise
III= SOB on min exercise
IV = SOBAR
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