EXAMINATION OF THE PATIENT WITH CARDIOVASCULAR SYSTEM DISEASES

EXAMINATION OF THE PATIENT WITH CARDIOVASCULAR SYSTEM DISEASES Propedeutics to internal medicine department Assistant professor Polskaya L. V.

Ischemic heart diseases: Angina pectoris Myocardial infarction Myocarditis Heart defects: Pericarditis Miral stenosis Miral insufficiency Aortic stenosis Aortic insufficiency Cardiomyopathy Essential hypertension

COMLAINTS: pain in the heart region palpitation intermissions dyspnoea attacks of asphyxia cough haemoptysis oedema heaviness or pain in the right hypochondrium headache, nausea, giddiness, noise in the ears or in the head

PAIN IN THE HEART REGION • location of the pain • irradiation of pain • character of pain: Ø feeling of heaviness or • duration of pain retrosternal pressure Ø boring Ø piercing Ø acute • cause or condition under which it develops: üexercise, walking üemotional stress üattack of pain at rest or during night sleep • conditions under which the pain abates

Palpitation - accelerated or intensified heart contractions heavy physical load §Healthy persons emotional stress smoking §Heart affection coffee abuse §Affections of the adjacent organs stomach ulcer myocarditis cholelithiasis myocardial infarction acute pancreatitis fever, anemia, neurosis, hyperthyroidism, after administration of some heart failure and medicinal preparations Intermissions (escaped beats) – disorders of the cardiac rhythm

Dyspnea Attacks of asphyxia Cough cardiac asthma Hemoptysis pulmonary oedema Congestion of the blood in lesser circulation

Oedema hydrothorax hydropericardium on the leg Heaviness in the abdomen ascites anasarca Pain or heaviness in the right hypochondrium Poor appetite, nausea, vomiting and swelling of the abdomen Congestion of the blood in greater circulation

Headache Nausea Noise in the ears or in the head Elevated temperature Weakness, rapid fatigue, decreased work capacity, increased excitability, and deranged sleep BP

COMMON INSPECTION: General appearance Posture in the bed Corvisart's face Facies mitralis orthopnea Skin color: • central cyanosis Dyspnoea • peripheral cyanosis - acrocyanosis Visible oedema: • on the legs • hydrothorax • ascites • anasarca Shape of the terminal finger phalanges drumstick fingers with nails like watch glasses

NECK INSPECTION: Carotid pulsation: • aortic insufficiency • atrial fibtillation • thyrotoxicosis Dilation of the jugular vein right ventricle failure Jugular vein pulsation positive venous pulse: • true • false tricuspid regurgitation carotid pulsation

HEART REGION INSPECTION: • Pulsation in the jugular fossae: aneurysm of the aortic arch • Pulsation in the II costal interspace to the right of the sternum: dilation or aneurysm of the ascending part of aorta • Pulsation in the II costal interspace to the left of the sternum: aneurysm of the pulmonary trunk

• Pulsation in the III-IV costal interspace to the left of the sternum - cardiac beat contractions of the enlarged (hypertrophied) right ventricle cardiac humpback • Pulsation in the V costal interspace medially to the left of the midclavicular line - apex beat contractions of the enlarged (hypertrophied) left ventricle negative apex beat adhesive pericarditis • Epigastric pulsation