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THE HEART AND
CARDIOVASCULAR
SYSTEM
SIR WILLIAM OSLER
Never forget to look at
the back of a patient.
Always look at the feet.
Looking at a woman’s
legs has often saved
her life.
THE CARDIOVASCULAR SYSTEM
ASSESSMENT SEQUENCE
• 1. Presenting symptoms (e.g. chest pain,
dyspnoea, palpitations, peripheral oedema)
• 2. Detailed questions about presenting symptoms
(SOCRATES)
• 3. Questions about previous cardiac problems
and cardiac risk factors (past, social and family
history)
• 4. A general inspection of the patient
THE CARDIOVASCULAR
SYSTEM ASSESSMENT
SEQUENCE
• 5. Examination for
peripheral signs of
cardiovascular disease,
• including the pulses and
blood pressure
• 6. Examination of the neck
(carotid pulse and jugular
venous pressure)
THE
CARDIOVASCULAR
SYSTEM
ASSESSMENT
SEQUENCE
•7. Examination of
the precordium
including the
apex beat, heart
•sounds and
murmurs
THE
CARDIOVASCULAR
SYSTEM
ASSESSMENT
SEQUENCE
• 8. Examination of the
lung fields*** for signs of
cardiac failure
• 9. Examination of the
legs for oedema
• 10. Provisional and
differential diagnosis
PAST HISTORY
• Rheumatic fever, chorea, recent (past 3
months) dental work, thyroid disease
• Prior medical examination revealing heart
disease (e.g. military, school, insurance)
• Drugs
•Social history
•Smoking habits and alcohol use
•Family history
•Myocardial infarcts, cardiomyopathy,
congenital heart disease, mitral valve
prolapse, Marfan’s syndrome
CORONARY ARTERY DISEASE RISK
FACTORS
1. Previous coronary or vascular disease
2. Hyperlipidaemia
3. Hypertension
4. Smoking
5. Family history of coronary artery disease
6. Diabetes mellitus
7. Obesity and physical inactivity
8. Male sex and advanced age
THE CARDIOVASCULAR HISTORY- MAJOR SYMPTOMS
Chest pain, tightness, discomfort or heaviness
Dyspnoea: exertional (note degree of exercise necessary),
orthopnoea, paroxysmal nocturnal dyspnoea
Ankle swelling
Palpitations
Syncope and dizziness
Intermittent claudication
Fatigue
ANKLE SWELLING
PALPITATIONS
INTERMITTENT CLAUDICATION

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