cvs presentaton

7/28/2019 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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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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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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