The Art and Science of Cardiac Physical Examination (eBook)

With Heart Sounds and Pulse Wave Forms on CD

Narasimhan Ranganathan, Vahe Sivaciyan, Franklin B. Saksena (Autoren)

eBook Download: PDF

2007 | 2007
XVIII, 412 Seiten
Humana Press (Verlag)
978-1-59745-023-2 (ISBN)

Infos

It has been our experience that instruction in physical examination of the heart in medical schools has been deteriorating since the advent of such modern diagnostic tools as two-dimensional echocardiography and nuclear imaging. At best, the teaching has been sketchy and too superficial for the student to appreciate the pathophysiological correlates. Both invasive and the noninvasive modern technologies have contributed substantially to our knowledge and understanding of cardiac physical signs and their pathophysiological correlates. However, both students and teachers alike appear to be mesmerized by technological advances to the neglect of the age-old art, as well as the substantial body of science, of cardiac physical examination. It is also sad to see reputed journals give low priority to articles related to the clinical examination. Our experience is substantiated by a nationwide survey of internal medicine and cardiology training programs, which concluded that the teaching and practice of cardiac auscultation received low emphasis, and perhaps other bedside diagnostic skills as well (1). The state of the problem is well reflected in the concerns expressed in previous publications (2-4), including the 2001 editorial in the American Journal of Medicine (Vol. 110, pp. 233-235), entitled 'Cardiac auscultation and teaching rounds: how can cardiac auscultation be resuscitated?', as well as in the rebuttal, 'Selections from current literature. Horton hears a Who but no murmurs-does it matter?' (5).

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It has been our experience that instruction in physical examination of the heart in medical schools has been deteriorating since the advent of such modern diagnostic tools as two-dimensional echocardiography and nuclear imaging. At best, the teaching has been sketchy and too superficial for the student to appreciate the pathophysiological correlates. Both invasive and the noninvasive modern technologies have contributed substantially to our knowledge and understanding of cardiac physical signs and their pathophysiological correlates. However, both students and teachers alike appear to be mesmerized by technological advances to the neglect of the age-old art, as well as the substantial body of science, of cardiac physical examination. It is also sad to see reputed journals give low priority to articles related to the clinical examination. Our experience is substantiated by a nationwide survey of internal medicine and cardiology training programs, which concluded that the teaching and practice of cardiac auscultation received low emphasis, and perhaps other bedside diagnostic skills as well (1). The state of the problem is well reflected in the concerns expressed in previous publications (2-4), including the 2001 editorial in the American Journal of Medicine (Vol. 110, pp. 233-235), entitled "e;Cardiac auscultation and teaching rounds: how can cardiac auscultation be resuscitated?"e;, as well as in the rebuttal, "e;Selections from current literature. Horton hears a Who but no murmurs-does it matter?"e; (5).

Inhalt

PREFACE 7
ACKNOWLEDGMENT 10
CONTENTS 11
1 Approach to the Physical Examination of the Cardiac Patient 16
REASONS FOR WHICH CARDIAC ASSESSMENT IS SOUGHT 17
CARDIAC SYMPTOMS AND THEIR APPRAISAL 17
GENERATION OF WORKING LIST OF POSSIBLE DIAGNOSES 19
FOCUSED PHYSICAL EXAMINATION: 21
FOCUSED CARDIAC PHYSICAL EXAMINATION: 29
2 Arterial Pulse 30
PHYSIOLOGY OF THE ARTERIAL PULSE 30
ASSESSMENT OF THE ARTERIAL PULSE 49
PRACTICAL POINTS IN CLINICAL ASSESSMENT OF THE ARTERIAL PULSE 59
REFERENCES 61
3 Blood Pressure and Its Measurement 64
PHYSIOLOGY OF BLOOD FLOW AND BLOOD PRESSURE 64
PHYSIOLOGY OF BLOOD PRESSURE MEASUREMENT 65
POINTS TO REMEMBER WHEN MEASURING BLOOD PRESSURE 67
FACTORS THAT AFFECT BLOOD PRESSURE READINGS 68
INTERPRETATION OF BLOOD PRESSURE MEASUREMENTS 69
USE OF BLOOD PRESSURE MEASUREMENT IN SPECIAL CLINICAL SITUATIONS 71
REFERENCES 79
4 Jugular Venous Pulse 82
NORMAL RIGHT ATRIAL PRESSURE PULSE CONTOURS 83
JUGULAR VENOUS INFLOW VELOCITY PATTERNS AND THE RELATIONSHIP TO THE RIGHT ATRIAL PRESSURE PULSE 85
JUGULAR VENOUS FLOW EVENTS AND THEIR RELATIONSHIP TO JUGULAR VENOUS PULSE CONTOURS 89
NORMAL JUGULAR VENOUS PULSE CONTOUR AND ITS RECOGNITION AT THE BEDSIDE 96
INDIVIDUAL COMPONENTS OF THE RIGHT ATRIAL PRESSURE PULSE, THEIR DETERMINANTS, AND THEIR RECOGNITION IN THE JUGULARS 97
ABNORMAL JUGULAR VENOUS PULSE CONTOURS AS RELATED TO ABNORMAL JUGULAR VENOUS FLOW VELOCITY PATTERNS 107
ABNORMAL JUGULAR CONTOURS 111
ASSESSMENT OF JUGULAR VENOUS PRESSURE 120
CLINICAL ASSESSMENT OF THE JUGULAR VENOUS PULSE 122
REFERENCES 125
5 Precordial Pulsations 127
MECHANICS AND PHYSIOLOGY OF THE NORMAL APICAL IMPULSE 127
PHYSICAL PRINCIPLES GOVERNING THE FORMATION OF THE APICAL IMPULSE 129
NORMAL APICAL IMPULSE AND ITS DETERMINANTS 132
ASSESSMENT OF THE APICAL IMPULSE 134
LEFT PARASTERNAL AND STERNAL MOVEMENTS 147
RIGHT PARASTERNAL MOVEMENT 148
PULSATIONS OVER THE CLAVICULAR HEADS 148
PULSATIONS OVER THE SECOND AND/ OR THIRD LEFT INTERCOSTAL SPACES 149
SUBXIPHOID IMPULSE 149
PRACTICAL POINTS IN THE CLINICAL ASSESSMENT OF PRECORDIAL PULSATIONS 150
REFERENCES 152
6 Heart Sounds 154
PRINCIPLES OF SOUND FORMATION IN THE HEART 154
FIRST HEART SOUND (S1) 155
CLINICAL ASSESSMENT OF S1 AND COMPONENTS 169
SECOND HEART SOUND (S2) 171
NORMAL S2 172
ABNORMAL S2 175
CLINICAL ASSESSMENT OF S2 187
OPENING SNAP (OS) 192
THIRD HEART SOUND (S3) 198
CLINICAL ASSESSMENT OF S3 211
FOURTH HEART SOUND (S4) 213
CLINICAL ASSESSMENT OF S4 217
REFERENCES 219
7 Heart Murmurs I 224
PRINCIPLES GOVERNING MURMUR FORMATION 224
HEMODYNAMIC FACTORS AND CARDIAC MURMURS 227
FREQUENCIES OF MURMURS 227
GRADING OF MURMURS 229
SYSTOLIC MURMURS 229
EJECTION MURMURS 230
REGURGITANT SYSTOLIC MURMURS 245
MITRAL REGURGITATION 246
TRICUSPID REGURGITATION 266
VENTRICULAR SEPTAL DEFECT (VSD) 271
CLINICAL ASSESSMENT OF SYSTOLIC MURMURS 278
REFERENCES 282
8 Heart Murmurs II 293
DIASTOLIC MURMURS 293
DIASTOLIC MURMURS OF MITRAL ORIGIN 293
DIASTOLIC MURMURS OF TRICUSPID ORIGIN 300
SEMILUNAR VALVE REGURGITATION 301
AORTIC REGURGITATION 301
PULMONARY REGURGITATION 308
CLINICAL ASSESSMENT OF DIASTOLIC MURMURS 310
CONTINUOUS MURMURS 312
PERSISTENT DUCTUS ARTERIOSUS 314
AORTO-PULMONARY WINDOW 316
SINUS OF VALSALVA ANEURYSM 316
CORONARY ARTERIOVENOUS FISTULAE 317
VENOUS HUM 318
MAMMARY SOUFFLE 318
CLINICAL ASSESSMENT OF CONTINUOUS MURMURS 318
PERICARDIAL FRICTION RUB 320
INNOCENT MURMURS 321
REFERENCES 322
9 Elements of Auscultation 326
THE STETHOSCOPE 326
AUSCULTATION METHOD 327
REFERENCES 335
10 Pathophysiological Basis of Symptoms and Signs in Cardiac Disease 337
PATHOPHYSIOLOGY OF MITRAL REGURGITATION 337
PATHOPHYSIOLOGY OF AORTIC REGURGITATION 341
PATHOPHYSIOLOGY OF MITRAL STENOSIS 345
PATHOPHYSIOLOGY OF AORTIC STENOSIS 347
PATHOPHYSIOLOGY OF MYOCARDIAL ISCHEMIA/INFARCTION 350
PATHOPHYSIOLOGY OF HYPERTENSIVE HEART DISEASE 352
PATHOPHYSIOLOGY OF DILATED CARDIOMYOPATHY 354
PATHOPHYSIOLOGY OF HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY 356
PATHOPHYSIOLOGY OF ATRIAL SEPTAL DEFECT 358
PATHOPHYSIOLOGY OF DIASTOLIC DYSFUNCTION 361
PATHOPHYSIOLOGY OF CONSTRICTIVE PERICARDITIS 363
PATHOPHYSIOLOGY OF CARDIAC TAMPONADE 364
APPENDIX 367
REFERENCES 372
11 Local and Systemic Manifestations of Cardiovascular Disease 376
GENERAL OBSERVATIONS 376
CONGENITAL SYNDROMES/DISEASES 379
VASCULAR DISEASES 384
VALVULAR HEART DISEASE 387
ENDOCRINE AND METABOLIC DISEASES 388
INFLAMMATORY DISEASES 392
DISEASES OF CONNECTIVE TISSUE AND JOINTS 392
PHARMACOLOGICAL AGENTS 396
MUSCULOSKELETAL DISEASES 399
TUMORS 401
SYNOPSIS 401
ACKNOWLEDGMENT 405
REFERENCES 405
INDEX 411
ABOUT THE AUTHORS 426

Produkt-Details

• Erscheint lt. Verlag: 10.11.2007
• Reihe/Serie: Contemporary Cardiology
• Reihe/Serie: Contemporary Cardiology
• Zusatzinfo: XVIII, 412 p. 251 illus., 12 illus. in color.
• Verlagsort: Totowa
• Sprache: englisch
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Kardiologie / Angiologie
• Themenwelt: Studium ► 2. Studienabschnitt (Klinik) ► Anamnese / Körperliche Untersuchung
• Schlagworte: Aneurysm • Blood pressure • Cardiovascular • Echocardiography • heart • Internal Medicine • pathophysiology • Physiology • Stent • vascular disease
• ISBN-10: 1-59745-023-5 / 1597450235
• ISBN-13: 978-1-59745-023-2 / 9781597450232