The Art And Science of Cardiac Physical Examination

by Ranganathan, Narasimhan; Sivaciyan, Vahe; Saksena, Franklin B.

• ISBN13: 9781588297761
• ISBN10: 1588297764
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-09-30
• Publisher: Humana Pr Inc

Summary

A panel of academic clinicians brings the art and science of the clinical cardiac examination to the bedside with a tour de force tutorial on the techniques needed to elicit various physical signs and to interpret them in relation to the patient's symptoms and underlying cardiac condition. Drawing on twenty-five years of teaching and training physicians and physicians-to-be, the authors integrate the physiology, pathophysiology, and mechanisms behind the various physical signs with a thorough and easy-to-use practical approach that makes physician feel more comfortable and competent performing the cardiac physical examination. The authors pay particular attention to the interpretation of the jugular venous pulsations and contour and make the physiology and pathophysiology of the normal and abnormal arterial pulse interesting and relevant. A unique and original companion video CD presents close to 140 clinical examples taken from actual patients, complete with audio recordings of various heart sounds and murmurs displayed in real time as seen on an oscilloscope. Additional video recordings show both precordial pulsations and jugular pulsations from patients with a variety of cardiac lesions, and illustrate certain unusual clinical conditions through simultaneous echocardiographic images and recordings of heart sounds and murmurs.

Table of Contents

Preface	vii
Acknowledgment	x
Companion CD	xv
Color Plates	xvii
Approach to the Physical Examination of the Cardiac Patient	1	(14)
Reasons for Which Cardiac Assessment Is Sought	2	(1)
Cardiac Symptoms and Their Appraisal	2	(2)
Generation of Working List of Possible Diagnoses	4	(2)
Focused Physical Examination: Clinical Exercise	6	(8)
Focused Physical Examination: Practical Points	14	(1)
Arterial Pulse	15	(34)
Physiology of the Arterial Pulse	15	(19)
Assessment of the Arterial Pulse	34	(10)
Practical Points in the Clinical Assessment of the Arterial Pulse	44	(2)
References	46	(3)
Blood Pressure and Its Measurement	49	(18)
Physiology of Blood Flow and Blood Pressure	49	(1)
Physiology of Blood Pressure Measurement	50	(2)
Points to Remember When Measuring Blood Pressure	52	(1)
Factors That Affect Blood Pressure Readings	53	(1)
Interpretation of Blood Pressure Measurements	54	(2)
Use of Blood Pressure Measurement in Special Clinical Situations	56	(8)
References	64	(3)
Jugular Venous Pulse	67	(46)
Normal Right Atrial Pressure Pulse Contours	68	(2)
Jugular Venous Inflow Velocity Patterns and the Relationship to the Right Atrial Pressure Pulse	70	(4)
Jugular Venous Flow Events and Their Relationship to Jugular Venous Pulse Contours	74	(7)
Normal Jugular Venous Pulse Contour and Its Recognition at the Bedside	81	(1)
Individual Components of the Right Atrial Pressure Pulse, Their Determinants, and Their Recognition in the Jugulars	82	(10)
Abnormal Jugular Venous Pulse Contours as Related to Abnormal Jugular Venous Flow Velocity Patterns	92	(4)
Abnormal Jugular Contours	96	(9)
Assessment of Jugular Venous Pressure	105	(2)
Clinical Assessment of the Jugular Venous Pulse	107	(3)
References	110	(3)
Precordial Pulsations	113	(28)
Mechanics and Physiology of the Normal Apical Impulse	113	(2)
Physical Principles Governing the Formation of the Apical Impulse	115	(3)
Normal Apical Impulse and Its Determinants	118	(2)
Assessment of the Apical Impulse	120	(13)
Left Parasternal and Sternal Movements	133	(1)
Right Parasternal Movement	134	(1)
Pulsations Over the Clavicular Heads	134	(1)
Pulsations Over the Second and/or Third Left Intercostal Spaces	135	(1)
Subxiphoid Impulse	135	(1)
Practical Points in the Clinical Assessment of Precordial Pulsations	136	(2)
References	138	(3)
Heart Sounds	141	(70)
Principles of Sound Formation in the Heart	141	(1)
First Heart Sound (S1)	142	(14)
Clinical Assessment of S1 and Components	156	(2)
Second Heart Sound (S2)	158	(1)
Normal S2	159	(3)
Abnormal S2	162	(12)
Clinical Assessment of S2	174	(5)
Opening Snap (OS)	179	(6)
Third Heart Sound (S3)	185	(13)
Clinical Assessment of S3	198	(2)
Fourth Heart Sound (S4)	200	(4)
Clinical Assessment of S4	204	(2)
References	206	(5)
Heart Murmurs: Part I	211	(64)
Principles Governing Murmur Formation	211	(3)
Hemodynamic Factors and Cardiac Murmurs	214	(1)
Frequencies of Murmurs	214	(2)
Grading of Murmurs	216	(1)
Systolic Murmurs	216	(1)
Ejection Murmurs	217	(15)
Regurgitant Systolic Murmurs	232	(1)
Mitral Regurgitation	233	(20)
Tricuspid Regurgitation	253	(5)
Ventricular Septal Defect (VSD)	258	(7)
Clinical Assessment of Systolic Murmurs	265	(4)
References	269	(6)
Heart Murmurs: Part II	275	(34)
Diastolic Murmurs	275	(1)
Diastolic Murmurs of Mitral Origin	275	(7)
Diastolic Murmurs of Tricuspid Origin	282	(1)
Semilunar Valve Regurgitation	283	(1)
Aortic Regurgitation	283	(7)
Pulmonary Regurgitation	290	(2)
Clinical Assessment of Diastolic Murmurs	292	(2)
Continuous Murmurs	294	(2)
Persistent Ductus Arteriosus	296	(2)
Aorto-Pulmonary Window	298	(1)
Sinus of Valsalva Aneurysm	298	(1)
Coronary Arteriovenous Fistulae	299	(1)
Venous Hum	300	(1)
Mammary Souffle	300	(1)
Clinical Assessment of Continuous Murmurs	300	(2)
Pericardial Friction Rub	302	(1)
Innocent Murmurs	303	(1)
References	304	(5)
Elements of Auscultation	309	(12)
The Stethoscope	309	(1)
Auscultation Method	310	(8)
References	318	(3)
Pathophysiological Basis of Symptoms and Signs in Cardiac Disease	321	(40)
Pathophysiology of Mitral Regurgitation	321	(4)
Pathophysiology of Aortic Regurgitation	325	(4)
Pathophysiology of Mitral Stenosis	329	(2)
Pathophysiology of Aortic Stenosis	331	(3)
Pathophysiology of Myocardial Ischemia/Infarction	334	(2)
Pathophysiology of Hypertensive Heart Disease	336	(2)
Pathophysiology of Dilated Cardiomyopathy	338	(2)
Pathophysiology of Hypertrophic Obstructive Cardiomyopathy	340	(2)
Pathophysiology of Atrial Septal Defect	342	(3)
Pathophysiology of Diastolic Dysfunction	345	(2)
Pathophysiology of Constrictive Pericarditis	347	(1)
Pathophysiology of Cardiac Tamponade	348	(3)
Appendix	351	(5)
References	356	(5)
Local and Systemic Manifestations of Cardiovascular Disease	361	(36)
General Observations	361	(3)
Congenital Syndromes/Diseases	364	(5)
Vascular Diseases	369	(3)
Valvular Heart Disease	372	(1)
Endocrine and Metabolic Diseases	373	(4)
Inflammatory Diseases	377	(1)
Diseases of Connective Tissue and Joints	377	(4)
Pharmacological Agents	381	(3)
Musculoskeletal Diseases	384	(2)
Tumors	386	(1)
Synopsis	386	(4)
Acknowledgment	390	(1)
References	390	(7)
Index	397	(16)
About the Authors	413