CARDIOVASCULAR SEMIOLOGY PHYSICAL EXAMINATION

1. CARDIOVASCULAR SEMIOLOGYPHYSICAL EXAMINATION Dr. Nechita Alexandru

3. CARDIOVASCULAR PHYSICAL EXAMINATION INSPECTION GENERAL INSPECTION INSPECTION OF THE ANTERIOR THORAX.

4. CARDIOVASCULAR PHYSICAL EXAMINATION INSPECTION GENERAL INSPECTION FACIES CONSTITUTIONAL TYPE PSYCHIC STATUS SPEAKING DECUBITUS OTRHOSTATISM AND WALKING

5. CARDIOVASCULAR PHYSICAL EXAMINATION INSPECTION EXAMINATION OF SKIN, MUCOSAE AND SUBCUTANEOUS TISSUE. CYANOSIS PALOR TELEANGIECTASIS JAUNDICE NAILS ERITEMA FINGERS

6. CARDIOVASCULAR PHYSICAL EXAMINATION INSPECTION INSPECTION OF THE ANTERIOR THORACIC REGION INSPECTION OF THE ANTERIOR VERVICAL REGION. INSPECTION OF THE PRECORDIAL REGION INSPECTION OF THE RIGHT THORACIC REGION AND OF THE INFERIOR STERNAL REGION.

7. CARDIOVASCULAR PHYSICAL EXAMINATION INSPECTION PERIODS STATIC DYNAMIC

8. CARDIOVASCULAR PHYSICAL EXAMINATION INSPECTION OF THE ANTERIOR CERVICAL REGION CAROTID PULSATION (ARTERIAL DANCE) JUGULAR PULSATION JUGULAR TURGOR AORTIC PULSATION

9. CARDIOVASCULAR PHYSICAL EXAMINATION INSPECTION OF THE PRECORDIAL REGION VISIBLE APICAL IMPULSE LEFT VENTRICULAR ANURYSM AORTIC ANEURYSM

10. CARDIOVASCULAR PHYSICAL EXAMINATION INSPECTION OF THE RIGHT HEMITHORAX AND STERNAL REGION AORTIC ANEURYSM LIVER PULSATIONS RIGHT VENTRICULAR IMPULSE

11. CARDIOVASCULAR PHYSICAL EXAMINATION PALPATION ANTERIOR CERVICAL REGION STERNAL NOTCH APICAL IMPULSE MEZOCARDIAC REGION AUSCULTATION AREAS IRRADIATION AREAS EPIGASTRIC REGION

12. CARDIOVASCULAR PHYSICAL EXAMINATION PALPATION APICAL IMPULSE LOCATION SURFACE AMPLITUDE UNICITY RITHMICITY

13. CARDIOVASCULAR PHYSICAL EXAMINATION PALPATION AREAS- FOCI CARDIAC SOUNDS EQUIVALENTS THRILLS �palpable vibrations from murmurs or bruits- grade 4/6 or louder. PERICARDIAL RUB.

14. CARDIOVASCULAR PHYSICAL EXAMINATION PERCUSSION 2 MOMENTS SUPERFICIAL DEEP. LOCATION OF THE CARDIAC DULLNESS

15. CARDIOVASCULAR PHYSICAL EXAMINATION PERCUSSION

16. CARDIAC AUSCULTATION 

17. CARDIAC AUSCULTATION DIRECT CORRELATION BETWEEN HEMODYNAMIC PHENOMENA � ACOUSTIC PHENOMENA = ACURACY OF THE CONCLUSION PRACTICABLE IN ANY CONDITIONS C. A.

18. CARDIAC AUSCULTATION BIAURICULAR STHETOSCOPE AURICULAR PIECE: COMFORTABLE TUBES: 25 � 30cm, lumen ? 3mm CHEST PIECE: FLAT RESPONSE CURVE FOR: 50 � 1200 Hz TECHNIQUE QUIET ROOM WE LISTEN FOR LOW FREQUENCIES HIGH FREQUENCIES COMFORTABLE POSITION PACIENT IN DORSAL DECUBITUS SPECIFIC MANOEUVRES ORTHOSTATISM

19. AUSCOULTAION FOCI(AREAS)

20. HEART SOUNDS � � TUM � TA � � TUM � TA � � SOUND I FREQUENCY � VARIABLE RHYTHMICITY � VARIABLE INTENSITY � INTENSE PITCH � LOWER DURATION � LONGER DELIMITATION � LESS CLEAR AUDIBILITY � MITRAL AREA

21. HEART SOUNDS SOUND II FRECUENCY � VARIABLE RHYTHMICITY � VARIABLE INTENSITY � LESS INTENSE PITCH � HIGHER DURATION � SHORTER LIMITS � CLEAR AUDIBILITY � BASE OF THE HEART.

22. HEART SOUNDS

23. CONCOMITANT SEPPARATE CHANGES IN HEART SOUNDS

24. DIMINUATION ENHANCEMENT CHANGES IN HEART SOUNDS

25. SOUND I INTENSITY IS DETERMINED BY: POSITION OF THE CUSPS. VALVULAR INTRINSIC MOBILITY. LV CONTRACTION VELOCITY MITRAL VALVE COMPLETE CLOSURE. OTHER BIOLOGICAL AND PHYSICAL CHARACTERISTICS OF THE VALVES. CHANGES IN SOUND I

26. EHANCEMENT NONCALCIFIED MITRAL STENOSIS. SCLEROUS VALVES. ENHANCEMENT OF SOUND I

27. SOUND I DIMINUATION

28. SOUND I DIMINUATION

29. VARIABLE S I SPLITTING OF S I 1 � MITRAL component 2 � TRICUSPID component PHYSIOLOGIC PATHOLOGIC - RBBB,LBBB - idioventricular rythm Changes in sound I

30. S II formed of � II A - II P ENHANCEMENT PHYSIOLOGIC � pulmonary area (? in inspiration) PATHOLOGIC AORTIC AREA (CLANGOR) hypertension AORTIC ATHEROMA PULMONARY AREA (pulmonary hypertension) MITRAL STENOSIS COR PULMONARE (�) Primary pulmonary hypertension Congenital heart disease Interatrial septal defect. Intensity changes for Sound II

31. DIMINUATION AORTIC area hypotension SHOCK AORTIC REGURGITATION AORTIC STENOSIS, CALCIFIED Pulmonary area PULMONARY VALVULAR STENOSIS CHANGES IN INTENSITY-SOUND II

32. SPLITTING PHYSIOLOGICAL - ONLY in the pulmonary area in INSPIRATION. PATHOLOGIC LARGE SPLITTING RBBB. PULMONARY VALVULAR STENOSIS MITRAL REGURGITATION FIXED SPLITTING (NO change in inspiration) ATRIAL SEPTAL DEFECT REVERSED SPLITTING LBBB AORTIC STENOSIS CHANGES IN INTENSITY-SOUND II

33. PHYSIOLOGIC - S III physiologic PATHOLOGIC SPLITTING of SI SPLITTING of SII CLICKS PROTOSYSTOLIC MEZOTELESYSTOLIC IZODIASTOLIC MITRAL VALVE OPENING. GALOPURI THREE STROKE CARDIAC RHYTHM

34. PPROTOSYSTOLIC CLICK Short, snaped , ejectional click Large psudosplitting of SI = SI + click AORTIC it can be listened in the mitral area. no obvious respiratory variation Noncalcified AS � aortic sclerosis. AR sometimes. PULMONARY pulmonary area disappearance in inspiration. CLICKS

35. MESOTELESYSTOLIC CLICK LARGE INTENSITY SHORT SNAPED VIBRANT SUPERFICIAL Also called � triolet sound. CLICKS

36. ISODIASTOLIC CLICK LARGE INTENSITY SHORT HIGH PITCH IT HAPPENS �UNDER THE EAR� MAXIMAL INTENSITY �LOWER STERNUM in CONSTRICTIVE PERICARDITIS. CLICKS

37. MITRAL OPENING CLICK (TRICUSP) LARGE INTENSITY SHORT IT IS PERCEIVED AT A DEFINITE DISTANCE FROM SII. BETTER HEARD AT THE APEX AND LOWER STERNUM CHARACTERISTIC FOR MS WITH NONCLCIFIED VALVES. IN MS, MITRAL DISEASE , MR (RARE) CLICKS

38. PATHOLOGICAL SOUNDS ONLY IN DIASTOLE LOW PITCH LOW INTENSITY DULL ARMONICS. GALLOPS

40. PRESYSTOLIC = S IV PATHOLOGIC CONNECTED TO THE ATRIAL SYSTOLE SIGN OF DIASTOLIC LV DYSFUNCTION-elevated filling pressure. CAUSES: HYPERTENSION LEFT VENTRICULAR HYPETROPHY CAD AMI HYPERTROPHIC CARDIOMYOPATHY concentric Severe Aortic Stenosis Third degree AV block. GALLOPS

41. PROTODIASTOLIC = S III pathologic Ventricular gallop SVERE LEFT VENTRICULAR DYSFUNCTION. PROGNOSIS ( 4 � 5 YEARS) CAUSES: CAD HYPERTENSION DILATED CARDIOMYOPATHIES EXCENTRIC HYPERTROPHIC CARDIOMYOPATHY. GALLOPS

42. MESODIASTOLIC = SUMMATION SUM OF THE S3 AND S4. TACHYCARDIA GRADE I AV BLOCK. RIGHT. LOWER EXTREMITY OF THE STERNUM ENHANCED IN POSTINSPIRATORY APNEEA. GALLOPS