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

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New York Heart Classification:

I = No SOB

II = SOB on mod exercise

III= SOB on min exercise

IV = SOBAR

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