cvs presentaton
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Examination of cardio vascular
system
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Common symptoms in cardio-vascular
system
Angina
Dyspnoea (At rest or on exertion?, orthopnea?,
Paroxysmal Nocturnal Dyspnoea)
Palpitation
Edema
Fatigue
Syncope
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RISK FACTORS
Smoking.
Obesity
Hypertension
High fat Diet
Physical activity or inactivity
Occupation: sedentary or active, and howactive?
Stress levels; occupational and others.
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Angina
Angina is the temporary chest pain or a
sensation of pressure that occurs when the
heart muscle is not receiving enough oxygen
Not everyone with ischemia experiences
angina.ischemia without angina is called silent
ischemia
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Types of angina
Nocturnal angina that occurs at night during sleep
Angina decubitus angina that occurs when the
patient is lying down
Variant angina angina at rest and not during
exertion
Spasm of one of large coronary arteries on surface of heart
Unstable angina
is a medical emergency.thereexists a varied patterns of symptoms severe pain
,increased frequency of pain
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Angina is felt as a pressure or ache beneaththe sternum
Either in shoulder or down the inside of eitherarm,through the back,in the throat,jaw,orteeth
Pain is felt in back and shoulders misdiagnosed as arthritis
Pain may occur in stomach area -
misdiagnosed as stomach ulcer
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Examination of the heart
Inspection: of jugular venous pulse and point
of maximal impulse
Palpation: of point of maximum impulse and
thrills
Auscultation: for valve closing sounds (S1and S2.
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JUGULAR VENOUS PULSE
The jugular venous pulse lies behind the
sternocleidomastoid muscle
To measure the JVP, incline the patient to 30-
45 degrees and use tangential light.
a jugular venous pulse more than 5 cm above
the sternal angle is a sign offluid overload or
abnormal cardiac function,right sided heart
disease
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PMI: POINT OF MAXIMUM IMPULSE
The point of maximal impulse (PMI) is the
(sometimes) visible and (usually) palpable
contraction of the left ventricle (LV) during
systole
It is usually located at the 5 th intercostal
space in the left midclavicular line, an
imaginary line down from the middle of theclavicle
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Pulse
Rhythm:
The most common irregularities are atrial arrhythmias and
extrasystoles (which may disappear on exertion)
Character:
water hammer - Thready, strong, bounding, collapsing
seen in
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Pulse
'pulsus paradoxus' - A pulse that weakens in inspiration is called (asopposed to the normal increase in volume)
constrictive pericarditis
pericardial effusion
restrictive cardiomyopathy
severe asthma.
'Pulsus alternans' - an alternate variation in size of pulse wave
is an important sign of left ventricular failure, but may be normal in thepresence of a fast ventricular rate.
'Pulsus bigeminus': groups of two heartbeats close together followed
by a longer pause. The second pulse is weaker than the first. premature ventricular contractions after every other beat.
hypertrophic obstructive cardiomyopathy
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AUSCULTATORY AREAS
aortic area or right sternal border (RSB) -right 2nd intercostal space
pulmonic area or left upper sternal border
(LUSB) - left 2 nd intercostal space tricuspid area or left lower sternal border
(LLSB) is at the left fourth intercostal space
mitral area or apex is at the PMI -- the 5 thintercostal space in midclavicular line
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AUSCULTATION OF THE HEART
be sure to use both sides of the stethoscope to
examine the heart
the diaphragm is best for hearing high-pitched
sounds, including S1, S2 and most heart murmurs
the bell is bests for hearing low-pitched sounds,
including S3, S4 and a few murmurs (e.g. mitral
stenosis) use LIGHT TOUCH when using the bell. Pressure
turns it into a diaphragm
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HEART SOUNDS
S1 closure of atrioventricular - mitral and
tricuspid Valves
S2 - closure of semilunar -- aortic and
pulmonic valves
S1 and S2
The Lub-dub sound of the heart is S1-S2.
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S1 sound
S1 is the sound made when the mitral andtricuspid (atrioventricular or AV) valves close.It marks the beginning of systole
S1 is loudest at apex or left lower sternalborder
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S2 sound
S2 is the sound made when the aortic and
pulmonic (semilunar) valves close. It marks
the beginning of diastole.
S2 is loudest at the base. The top of the heart
is the base.
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RHYTHM
Rhythm is usually regular.
Healthy young people often have a sinus
arrhythmia: their pulse is slower in expiration.
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HEART MURMURS
Heart murmurs are produced by turbulence
Causes of heart murmurs include:
increased blood flow across normal valves -for example, in pregnancy or hyperthyroidism,
or an innocent murmur), or
turbulent flow through abnormal valves: tight
valve (stenosis) or leaky valve (regurgitation or
insufficiency)
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HEART MURMURS: TIMING
Systolic: between S1 and S2 (during systole)
Diastolic: after S2
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COMMON SYSTOLIC MURMUR
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COMMON SYSTOLIC MURMUR:
MITRAL REGURGITATION
it is typically holosystolic -- heard throughoutsystole, often blurring S1 and S2
Mitral regurgitation murmurs are loudest at
the apex and often radiate to the axilla
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COMMON SYSTOLIC MURMUR:
AORTIC STENOSIS
they are diamond-shaped and have a harsher
quality
Aortic stenosis murmurs are most often
loudest in the aortic area (RSB), though they mayalso be loudes in the tricuspid area (LLSB)
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COMMON SYSTOLIC MURMUR:
MITRAL VALVE PROLAPSE
Mitral valve prolapse murmurs are heard bestat the apex
MVP murmur is classically a late systolicmurmur preceded by one or more midsystolicclicks
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A COMMON DIASTOLIC MURMUR: AORTIC
INSUFFICIENCY
It occurs early in diastole
Aortic insufficiency murmur is loudest in the aortic ortricuspid area
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HEART MURMUR
Mitral stenosis
Aortic regurgitation
Mitral regurgitation
Aortic stenosis
Mid-diastolic murmur
Diastolic murmur
Holosystolic murmur
Mid-systolic ejection
murmur
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