Post on 11-Oct-2015
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Physical Examination ofThe Cardiovascular SystemCardiovascular DepartmentWahidin Sudirohusodo General HospitalMakassar
ANATOMYAnterior Surface of the Heart
ANATOMYThe Sectional Anatomy of the Heart
CARDIAC CYCLE
PHYSICAL EXAMINATIONThe jugular venous pressureThe arterial pulseThe PMI and any heaves, lifts, or bruitsThe S1 and S2Extra sounds both in systole and diastoleCardiac murmurs
JUGULAR VENOUS PRESSURESTEPS FOR ASSESSING JVP :Raise the head slightly on a pillowRaise the head of the bed to 30oUse tangential lighting to identify EJV then IJVRaise or lower the head of the bed to see oscillation pointIdentify the highest point of pulsation
JUGULAR VENOUS PRESSURE
JUGULAR VENOUS PRESSURE
JUGULAR VENOUS PRESSURENormal pressure (30o) 3-4 cm above the sternal angleHypovolemic patients 0oHypervolemic patients 60o 90o45o 4.5 cm above sternal angle
JUGULAR VENOUS PULSATIONNormal Jugular Venous Pulsation
JUGULAR VENOUS PULSATIONAbnormal A-WaveLarge A-wave &Slow Y-descent
JUGULAR VENOUS PULSATIONVentricularizedJVPAtrial Fibrillation
ARTERIAL PULSERadial artery, brachial artery, dorsalis pedis artery, femoral artery, carotid arteryAssess : volume, contour, frequency, and regularity
ARTERIAL PULSENormal pulse
Anacrotic pulse (pulsus parvus et tardus) AS
ARTERIAL PULSEPulsus bisferiens AR, AR+AS, IHSS
Pulsus alternans congestive heart failure
ARTERIAL PULSEPulsus paradoxus cardiac tamponade, constrictive pericarditis, COPD, hypovolemic shockWaterhammer pulse AR
ARTERIAL PULSE
EXAMINATION OF THE HEARTINSPECTION AND PALPATION
EXAMINATION OF THE HEARTINSPECTION AND PALPATION
EXAMINATION OF THE HEARTINSPECTION AND PALPATION
EXAMINATION OF THE HEARTPERCUSSIONEstimation of cardiac sizeCardiac dullness
HEART SOUNDSAUSCULTATIONS1 mitral and tricuspid valve S2 aortic and pulmonal valveS3 the rush of blood during early diastole S4 atrial contraction
HEART SOUNDSAUSCULTATION
HEART SOUNDSAUSCULTATION
HEART SOUNDSVariations of the S1
Tachycardia, mitral stenosis 1st degree AV Block, MR, CHF, CHDComplete heart block, AFRBBB, PVC
HEART SOUNDSVariations of the S1Splitting of S1
HEART SOUNDSVariations of the S2Splitting of S2
HEART SOUNDSVariations of the S2Increased A2 systemic hypertension, dilated aortic rootIncreased P2 pulmonary hypertension, dilated pulmonary artery, ASDDecreased A2 ASDecreased P2 increased AP diameter of the chest, PS
HEART SOUNDSExtra Heart Sounds in Systole
Aortic ejection sound : dilated aorta, aortic valve disease (congenital stenosis) Pulmonic ejection sound : dilated pulm. artery, PH, PSMitral Valve Prolapse (MVP)
HEART SOUNDSExtra Heart Sounds in Diastole
Mitral Stenosis (MS) Physiologic : children, pregnancy Pathologic : decreased myocardial contractility, myocardial failure, MR, TR Left-sided S4 : HHD, CAD, AS, cardiomyopathy Right-sided S4 : PH, PS
HEART SOUNDS (MURMURS)Midsystolic Murmurs
No evidence of CV disease. Found in : children, young adults, or even eldersTemporary increase in blood flow : anemia, fever, pregnancy, hyperthyroidism
HEART SOUNDS (MURMURS)
HEART SOUNDS (MURMURS)Pansystolic Murmurs
HEART SOUNDS (MURMURS)Diastolic Murmurs
HEART SOUNDS (MURMURS)Heart Sounds With Both Systolic and Diastolic Components
HEART SOUNDS (MURMURS)Heart Sounds With Both Systolic and Diastolic Components
HEART SOUNDS (MURMURS)Heart Sounds With Both Systolic and Diastolic Components
REFERENCESBickley, Lynn S. Bates Guide to Physical Examination and History Taking, 8th edition. Philadelphia : Lippincott Williams & Wilkins. 2003.
Braunwald, Eugene., Goldman, Lee. Primary Cardiology, 2nd edition. Philadelphia : Saunders. 2003.
Martini, F. H. Fundamentals of Anatomy and Physiology, 5th edition. New Jersey: Pretince Hall. 2001.
Akhtar Fajar Muzakkir, MDCardiac Centre, Wahidin Sudirohusodo Hospital0811462710/04115282327enzobearzot@yahoo.com
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