4. History of present illness
ďChest pain
⢠Gradual
⢠Diffuse
⢠Non âprogressive
⢠Non-radiating
⢠On and off
⢠NYHA-II
⢠Increases on exertion
5. ďDyspnoea
⢠Sudden
⢠On mild exertion
⢠NYHA-III
⢠Progressive
⢠Associated with palpitation
⢠Not associated with orthopnoea /PND
6. ⢠No history of syncope ,weakness of limb,
intermittent claudications, blurring of vision
,loss of weight, hemoptysis, frequent URTIâs,in
past.
7. Past history
⢠History of unconsiousness present 2 year back
last for about 1 min self reverted without any
neurological sequale.
⢠No history of HT/DM/ T.B/COPD in past.
⢠History of two LSCS opration present.
⢠History of penicillin prophylaxis present .
9. Social and personal history
⢠Middle class family
⢠2 live issues
⢠Started menses at age of 13 years regular,
normal cycle, normal flow
⢠Non-smoker ,non-alcoholic ,vegitarian
10. Drug history
⢠Taking penicillin prophylaxis since 2 years
⢠Taking Digoxin since past 6 month
⢠Taking Aspirin since past 6 month
11. General physical examination
⢠HR-90/min Irregularly irregular
⢠BP-130/70mmof Hg
⢠RR-20/min
⢠Temp-98.4 F
⢠SpO2-100% RA
Concious well oriented to time ,place and person .
No P/I/CY/CL/PE/LAP/JVP-NR
Well nourished BMI-27.7Kg/m2
12. Systemic examination
Inspection-Apex beat- 5th ICS just medial to mid -
clavicular line.
No visible pulsation in suprasternal notch and in
epigastrium
No scar mark on chest, supf. Varicosities
No visible chest defomity
14. Auscultation
Auscultation:
⢠Loud S1- as loud as S2 in aortic area
⢠P2 at mitral and aortic area
⢠Mid-Diastolic rumble, low pitched best heard
at the apex ,with the bell of stethoscope and
with patient in LL recumbent position.
Radiating to left axilla.
⢠OS ânot audible
15. ď˝ First heart sound (S1) is accentuated and snapping
ď˝ Opening snap (OS) after aortic valve closure
ď˝ Low pitch diastolic rumble at the apex
ď˝ Pre-systolic accentuation (esp. if in sinus rhythm)
Mitral Stenosis: Physical Exam
S1 S2 OS S1
16.
17. ⢠LAE
⢠RVH
⢠Premature contractions
⢠Atrial flutter and/or fibrillation
â ď freq. in pts with mod-severe MS for several years
â A fib develops in ďť 30% to 40% of pts w/symptoms
Mitral Stenosis: EKG