Cardiac History & ExaminationCardiac History & Examination

Jamil MayetJamil MayetConsultant CardiologistConsultant Cardiologist

St Mary’s HospitalSt Mary’s Hospital

Chest Pain• Character• Radiation• Relation with inspiration• Provocation• Grading

– Canadian Cardiovascular Society• I - Ordinary activity does not provoke• II - Slight limitation of ordinary activity• III - Marked limitation of ordinary activity (<1 flight steps)• IV – Inability to carry out physical activity

Dyspnoea

• Exertional• Orthopnoea• Paroxysmal nocturnal dyspnoea• NYHA Classification

– I - No SOB– II - SOB on severe exertion– III - SOB on mild exertion– IV – SOB at rest

Other Symptoms

• Palpitations– Regular / irregular– Fast / slow– Extra beats

• Syncope– Usually sudden and brief if cardiac cause– “Stokes-Adams” attacks

• Fatigue• Oedema

General examination

• Comfort / distress / resp rate• Scars• Bruising / needle marks• Chest wall motions• JVP / ankle oedema• IV infusions• Diabetic food / drinks

KEEP YOUR EYES OPEN

Hands

• Clubbing– Cyanotic Congenital Heart Disease– Bacterial Endocarditis

• Peripheral stigmata of endocarditis– Splinter haemorrhages– Osler nodes– Janeway lesions

• Peripheral cyanosis– Cardiac / Respiratory / Vasoconstriction

Pulse

• Radial– Rate– Rhythm– Volume– (Character)

Pulse

Blood Pressure

Appropriate cuff size

Palpate first

Slowly deflate

Korotkoff V

Eyes and mouth

• Anaemia

• Jaundice

• Xanthelesma

• Corneal arcus

• Central cyanosis

Carotid pulse

Jugular Venous Pressure

Jugular Venous Pressure

• A wave – atrial systole

• X descent – end of atrial systole

• C wave – transmission of rapidly increasing RV pressure just before TV closes

• V wave – venous return to RA during ventricular systole

• Y descent – TV opening

Jugular Venous Pressure

• Large a waves– Pulm ht, pulm stenosis, tricuspid stenosis

• Cannon a waves– A wave against closed TV

• CHB, VT, Junctional rhythm

• Giant v waves– Tricuspid regurgitation

Praecordium

Praecordium

Auscultation

Apex

LSE

Pulm

Aortic

1st sound

2nd sound

Systole

Diastole

Auscultation

Radiation of murmurs

Left side with bell at apex

Sat forward in expiration

Murmurs

• Systolic– Ejection

• Aortic, (pulmonary), flow murmurs

– Pan systolic• MR, (TR), (VSD)

• Diastolic– Early

• AR, (PR)

– Mid• MS, (TS)

Peripheral pulses