How to Examine the Heart Introduction and Inspection

How to Examine the Heart Introduction and Inspection © Continuing Medical Implementation …. . . bridging the care gap

How to Examine the Heart • Examine the heart from peripheral to central putting the pieces of the puzzle together as you go • By the time you put the stethoscope on the chest you should know what you will hear • Don’t leave the bedside and then try to figure out what you’ve heard. Be certain before the exam is over. © Continuing Medical Implementation …. . . bridging the care gap

Inspection Look for clues to the diagnosis © Continuing Medical Implementation …. . . bridging the care gap

Inspection • Go with the probabilities – Long thin people have long thin valves (MVP) – Males more likely to have aortic valve disease • Young-think bicuspid aortic valve • Middle age-think rheumatic AV disease • Elderly -think degenerative AV disease – Females- think mitral valve disease • MVP much more common than rheumatic MV disease © Continuing Medical Implementation …. . . bridging the care gap

Inspection Identify specific syndromes • Down syndrome – trisomy 21 – VSD • Turner syndrome – – Partialdeletion or absence of X chromosome – gonadal dysgenesis – aortic coarctation – bicuspid aortic valve – aortic dissection © Continuing Medical Implementation • Noonan’s syndrome – Dysmophic featureshort stature, webbed neck – Pulmonary stenosis – Hypertrophic cardiomyopathy • Marfan syndrome • Myotonic Dystrophy …. . . bridging the care gap

MARFAN Syndrome http: //www. io. com/~cortese/marfan/ photographs used with permission Body Habitus • Tall/thin/long facies • Long fingers – Thumb sign – Wrist sign • Ligamentous laxity • Scoliosis/kyphosis • Pectus excavatum/carinatum • Ectopia lentis • Narrow long facies • © High arched palate Continuing Medical Implementation …. . . bridging the care gap

Marfan’s Syndrome Habitus • Tall/thin/long facies • Long fingers – Thumb sign – Wrist sign • Ligamentous laxity • Scoliosis/kyphosis • Pectus excavatum/carinatum • Ectopia lentis © Continuing Medical Implementation • Aortic dissection • Dilatation of the aorta affecting sinuses of valsalva • MVP • Mitral regurgitation • LV dilatation • Dilated pulmonary artery < age 40 • MAC < age 40 …. . . bridging the care gap

Long fingers Ligamentous laxity © Continuing Medical Implementation …. . . bridging the care gap

Ectopia Lentis in Marfan Syndrome © Continuing Medical Implementation …. . . bridging the care gap

Myotonic Dystrophy • Autosomal dominant /variable penetrance • Myotonia • Wasting /weakness facial and distal muscles • Frontal balding • Cataracts • Cardiomyopathy • Conduction defects • Low intelligence or dementia © Continuing Medical Implementation …. . . bridging the care gap

Inspection • • • Clubbing Cyanosis Xanthoma and xanthelasma Arcus Pectus excavatum © Continuing Medical Implementation …. . . bridging the care gap

© Continuing Medical Implementation …. . . bridging the care gap

Differential Diagnosis of Clubbing • Cyanotic congenital heart disease • Lung disease – Cystic fibrosis – Interstitial fibrosis – Malignancy – Sarcoidosis – Bronchiectasis • Hyperthyroidism © Continuing Medical Implementation …. . . bridging the care gap

Arcus senilis (juvenilis) Arcus juvenilis. This ring is associated with premature atherosclerosis © Continuing Medical Implementation …. . . bridging the care gap

Xanthelasma © Continuing Medical Implementation …. . . bridging the care gap

Xanthoma • Nodular protuberance of the extensor surface of the leg (left panel) as well as multiple nodules of the arm (right panel) © Continuing Medical Implementation …. . . bridging the care gap

Eruptive xanthoma • Bulbous cutaneous eruptions associated with hyperlipidemia © Continuing Medical Implementation …. . . bridging the care gap

Pigmentation due to amiodarone © Continuing Medical Implementation …. . . bridging the care gap