GENERAL EXAMINATION OF CARDIAC PATIENTS:
Conscious level and mentality.
Appearance
Built
Complexion
Decubitus
Vital signs: (pulse, BP, Temperature, R.R.)
U.L & L.L.
Head & Neck
Other system review; Chest, Abdomen , Neurological, …
Summary flowchart for CVS EXAMINATION.
2. Topics Discussed:
Conscious level and mentality.
Appearance
Built
Complexion
Decubitus
Vital signs: (pulse, BP, Temperature, R.R.)
U.L & L.L.
Head & Neck
Other system review; Chest, Abdomen ,
Neurological, …
Summary flowchart for CVS EXAMINATION.
3. Conscious level and mentality.
Intellectual functions with cloudy mentality may be affected
with generalized atherosclerosis that also may lead to
Transient ischemic attack (T.I.A).
Embolic manifestations : M.S ,A.F. leads to Cerebral Stroke.
Hypertensive Encephalopathy (e.g. Posterior reversible
encephalopathy Syndrome (PRES) and cerebral Hge->Fits).
Pulmonary edema also affects the patient consciousness
especially after development of Respiratory Failure (hypoxia
+/- hypercapnia)
Disease Association CVS + NS:
Fridriech’s ataxia with Cardiomyopathy
Parkinson’s disease with primary orthostatic hypotension + syncope.
6. Cachexia
Cachexia refers to severe muscle and
fat loss, anorexia and marked weight
loss due to an underlying chronic
disease condition leading to lower life
expectancy.
The title cachexia, from the Greek
kakos (i.e., bad) and hexis (i.e.,
condition or appearance), or 'bad
condition‘.
7. Cachexia D.D.
Cachexia is a serious and underestimated
consequence in many conditions:
Cancer
Organ failure
Chronic conditions like chronic heart failure,
chronic kidney disease, chronic obstructive
pulmonary disease
Infectious diseases like tuberculosis, acquired
immunodeficiency syndrome(AIDS)
Inflammatory disorders like rheumatoid
arthritis
8. Built
1.Height:
Marfan's syndrome: (Tall+arachnodactyly+pes-
cavas-high arched palate+ ectopia lentis) dissecting
aortic aneurysm, aortic incompetence and MVP.
2.Dwarf undergrowth: Congenital heart disease or
in long standing heart disease since childhood.
2.Weight (BMI):
Underweight: Prolonged heart disease whatever
congenial or rheumatic.
Overweight: Atherosclerosis, HTN, MI.
3. Well developed upper part and under
developed lower part in coarctation of the aorta.
22. Jaundice:
Causes of jaundice in a cardiac patient:
1. Hemolytic J.: in pulmonary infarction, artificial
valves.
2. Hepato-cellular J.: in marked hepatic
congestion (cardiac cirrhosis)due to severe Rt.
sided HF - pericardial effusion -TS & TR.
3. Obstructive J.: bile & inspissation of bile in
canalicular lumen.
4. Associated viral hepatitis: the Commonest !!.
23.
24. Cyanosis
1. Central: Congenital cyanotic heart
disease (F4)- Advanced heart failure.
2. Peripheral: L.C.O.P., C.H.F., Peripheral
vascular disorders.
3. False (chemical) cyanosis:
Methemoglobinemia in nitrate ttt.
4. N.B.: "differential cyanosis": Means
cyanosis more apparent in lower part of
the body in reversed P.D.A.
29. Temperature
Fever in CVS:
IE
Rh.Fever
Chest infection
Pericarditis
Myocard. Infarction & pulm. Embolism
DVT and thrombophlepitis
Associated fever
30. Pulse:
Feel the right radial artery to
determine, pulse rate , rhythm, volume,
character equality (volume) in both upper
limbs, radiofemoral delay (Aortic
coarctation) and state of arterial wall.
One should also examine all
peripheral pulses in the carotides
brachial,femorals, post. tibial and dorsalis
pedis as routine specially in cardiac cases
with history of embolization.
40. R.R.
Tachypnea:
Pulm edema
H.F, MI, pulm. embolism
Associated chest infection.
Complication: Resp. Failure.
Distressed sweaty or clammy
('diaphoretic') Acute MI
41. Upper Limb
• 1-Dorsal aspect of the hands:
Tobacco "tar" staining
Peripheral cyanosis.
Temperature.
Clubbing(cyanotic HD or toxic I.E.)
I.E. THROMBOEMBOLC MANIFESTATIONS:
Splinter haemorrhages (linear, reddish brown marks along the
axis of the finger and to nails, thought to be due to circulating
immune complexes).
Jenway’s lesions
Oslar’s nodules
• Sc nodules
• Arthritis due to Rheumatic fever.
• Abnormal movement (chorea)
• Xanthomatas around tendons
42. Upper Limb
• 1-Dorsal aspect of the hands:
Tobacco "tar" staining
Peripheral cyanosis.
Temperature.
Clubbing(cyanotic HD or toxic I.E.)
I.E. THROMBOEMBOLC MANIFESTATIONS:
Splinter haemorrhages (linear, reddish brown marks,
multiple >2, along the axis of the finger and to nails,
thought to be due to circulating immune complexes).
Jenway’s lesions
Osler’s nodules
• Sc nodules (Rh. Fever).
• Arthritis due to Rheumatic fever.
• Abnormal movement (chorea) H.F.
• Xanthomatas around tendons
43. Upper Limb
2-Palmar aspect of the hands:
• Janeway lesions - painless red spots/macules, which blanch on
pressure, on the thenar/hypothenar eminences of the Palms, and
soles of the feet.
• Osler's nodes – small painful raised erythematous lesions
(nodules) which are rare but found most often on the pads of the
fingers (finger pulps) And toes representing digital microinfarction.
3-Palmar and extensor surfaces of the hands:
xanthomata (yellow skin or tendon nodules from lipid deposits).
4-Entire skin surface: petechiae.
60. Neck
Neck veins: venous waves and venous
pressure (Congestion) by examination of the
internal jugular vein (the window of the right
atrium).
Normally there is no congestion , but only normal
pulsation.
Thrill: Palpate the neck for thrill.
Causes:
A.S.Thyrotoxicosis, Aneurysm of carotid artery.
65. Abdomen
C-ABDOMINAL EXAMINATION:
1-Liver:-Enlarged & tender in: RVF,
pericardial disease-Enlarged, tender with
expansile pulsation: TR. TS-Enlarged firm,
with sharp border: cardiac cirrhosis
2-Spleen: enlarged in RVF, pericardial
disease3-Ascites: after edema in RVF, or
ascites precox in TR. TS. Pericardial
diseas.
66. BACK EXAMINATION:
1) Murmurs: - Bruit:of MR left scapolar regionOf coarctation
of aorta: interscapular region -Bnist of renal artery
stenosis in renal angle.
2) Crepitations:-Bilateral basal crepitation: LVF-Bubbling
coarse crepitations pulmonary edema
3) Ewart's sign: collapse of left lower lobe in pericardial
effusion
4) Vertebrae - Scapula:-Spina bifida: associated congenital
anomaly in congenital HD-Low back pain, stiffness &
limited spine mobility m ankylosing spondylitis
associated with AR -Anastomosis around scapula in
coarctation of aorta
5) Skin: Cafe au lait patches in neurofibromatosas
associated with pheochromocytoma & IHSS.
6) Sacral edema: pitting edema at sacral area in prolonged
bed ridden patients with Heart failure.