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Cardiovascular examination (format only)
- 1. Dr VISHESH ROHATGI MD, Dip Cardiology
- 2. • Name • Age • Sex • Marital status • Education • Occupation • Address
- 3. • Chief complaints • History of presenting illness • Angina – onset, position, nature, radiation, duration, progression, NYHA class, aggravating and relieving factors • Dyspnoea – orthopnoea and PND • Syncope • Fatigue • Palpitations – onset, duration, rate, rhythm, associated chest pain or pre syncope
- 4. • Associated features – ask for 1. Oliguria 2. Cerebrovascular accident 3. Sweating 4. Fever 5. Arrhythmia 6. Nausea, vomiting 7. Peripheral vascular disease 8. Cough 9. Hemoptysis 10. Headache 11. Dysphagia 12. Hoarseness of voice 13. Impotence 14. Nocturnal cramps
- 5. • Ischaemic heart disease • Asthma • COPD • Diabetes mellitus • Hypertension • Dyslipidemia • Acid peptic disease • Cardiac surgery • Chronic renal failure • Thyroid disease
- 6. • Coronary artery disease • Obesity
- 7. • Any previous medications should be mentioned
- 8. • Smoking • Alcohol • Bowel and bladder movements • Sleep • Diet
- 9. • Age of menarche • Duration, regular • Volume, clot • Menopause attained
- 10. • Conceived • Term • Living • Delivery mode • Hypertension • Edema / seizures developed in the antenatal or postnatal period - PIH
- 11. • History of cyanosis (peripheral / central) • Difficulty in feeding – slow, small volume feed, tiring easily, rest during feed • Poor growth • Difficulty in breathing • Respiratory infections • Squatting episodes
- 12. • Consanguinity – yes / no • Age of father • Age of mother • No of siblings • Rank of child • History of sibling with CHD / chromosomal abnormality
- 13. • Birth weight • Milestones
- 14. • Conscious, co-operative, well-oriented, lying comfortable • Height, weight, BMI • Teeth, Thyroid • Pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema • RF – joint swelling • IE – clubbing, splinter hemorrhages, osler nodes, Janeway lesions, Petechiae • Fundus – for IE, HTN signs • Signs of chromosomal anamoly- webbed neck, Hypertelorism, low-set ears, high arched palate
- 15. • Pulse rate – rate, rhythm, volume, character, peripheral pulses, radio-radial delay, radio-femoral delay, condition of arteries, bruit over peripheral pulses • Heart rate – to find PR-HR deficit • BP – sitting, lying, standing, upper limb and lower limb • Temperature • Respiratory rate – rate and type
- 16. • Jugular venous pressure – waves, respiratory change • Abdomino-jugular reflex
- 17. • Inspection • Chest wall defects like excavatum, carinatum, symmetrical, B/L moves with respiration • Precordial bulge • Apical impulse seen and position • Other pulsations seen including epigastric, carotid pulsations etc • Previous operation scar • Intercostal retractions in congenital
- 18. • Palpation • Tracheal position • Apical impulse – position, character • Parasternal heave • Thrills including carotid Percussion in PE, DCM
- 19. • Auscultation • First and second heart sound • Murmur • Area best heard • Systolic or diastolic • Timing and character (MDM, PSM etc) • Grading • Pitch – high or low • Bell or diaphragm • Conduction • Variation with respiration • Posture – best heard • Dynamic auscultation – exercise, Valsalva, standing
- 20. • Auscultate in other areas • Carotid • Inter and infra scapular • Axilla • Supra and infra clavicular Added sounds – S3, S4, OS, rub, Diastolic knock, Prosthetic valve sound, Tumor plop
- 21. THANK YOU