Chandana basnayake (m/98/83) Cvs medicine ANALYSIS OF CVS SYMPTOMS 1. Chest pain 2. Difficulty in breathin 3. !alpitati"n #.

$ybc"pal attack/Di%%iness Chest pain $table an ina & 'etr"sternal pain. $tart "n e(ersi"n. )nstable an ina & 'est pain. *+ ,"rtic dissecti"n !ericarditis -+ causes .es"pha itis .es"pha ial spasms /iarus hernia !eptic ulcer disease. !ancreatiis.

!ulm"nary causes. !ulm"nary emb"lism. !neum"nia !neum"th"ra(. ,cute asthma. !neum"th"ra(. .ther chest salll muscle pain !syc" enic chest pain C"st"ch"ndritis. Cervical sp"ndyl"sis. C/0$1 !,+2 D)0 1. *+ 'etr" sternal ti ht/ heavy/ c"nstrictive/ disc"mf"rt radiate t" neck3 4a53 "r b"th sh"ulder/arms/(left (c"mm"n) "r ri ht arm) *ay present 5ith pain in the referred site. 0. & e(ercise induced 4a5 pain. STABLE ANGINA !redictable sympt"m pattern. ,n ina pain is relieved by rest. 0pis"ds are tri ered by e(ersi"n "n em"ti"nal stress. -lyceryl trinitrate tablets ac666666 c"mplete res"luti"n. 7reathlessness may acc"mpany the chest disc"mf"rt. POST PRANDIAL ANGINA )nstable an ina & athr"mat"us pla8ues can fissurin 3 rupturin 3 dama e 9 emb"li

 C"r"nary artery spasms. $eri"us c"nditi"n defined clinically o .nset "f chest disc"mf"rt "f cardiac "ri in at rest. o !ain lastin f"r a l"n peri"d. 1:min/3; min pain devel"pin 5ith minimal e(erti"n. $everity increased !atient 5ith past chest pain lastin than m"re time c"mpare t" pre66 o !atient devel"ped it after intervene 0. & c"r"nary artery bypass. o <h" has *+ n"5 devel"ped pain very fre8uent. o Devel"pment "f abrupt "nset 666666666666 induced an ina 5ith marked limitati"n "f e(ercise capacity. o !atient devel"p chest pain first time "f life.9 s" admit the patient and d" full investi ati"ns. o *ay have a hist"ry "f crescend" an ina 5ith eff"rt t"lerance and increased fre8uency and devel"pment "f chest disc"mf"rt arise fe5 days and 666666 ACUTE MI Chest pain very severe !resentati"n very similar t" unstable an ina 3 nausea3 v"mitin 3 s5eatin . C"r"nary artery c"mpletely "bstructed by thr"mbus. )nstable an ina9 patial "bstructi"n. ,typical presentati"ns panin in the epi astric site 5ith"ut chest pain 4a5/arm/back pain.

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AORTIC DESSECTION $evere chest pain = sudden "nset. 1earin in nature. *ay radiate t" interscapular re i"n. ,t"nerve sym> Dependin "n e(tenti"n "ther sympt"ms may present. PULMONARY EMBOLISM ?;@ "f chest pain )sually pleuritic type . Difficulty in breathin usually. !alpitati"n3 ri ht heart "ri in. $ync"pal attacks may "ccur. ACUTE PERICADITIS o o o o o o $harp pain. 'etr" sternal "r left sided. *ay radiate t" trape%ium <"rse in inspirati"n and supine p"siti"n. *ay be relived by sittin p"siti"n. C"u hin and s5all"5in may a ravate the pain. BREATHLESSNESS Cardiac3 respirat"ry3 thyr"t"(ic"sis3 anaemia.

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,lm"st all types "f cardiac illnesses can cause breathlessness. Ae5 cat" "ries. i. pulm"nary edema ii. reduced cardiac "utput iii. .bstructi"n "f cardiac "ut put9 hiatus sten"sis3 hypertr"phic cardiac disease. iv. ,rrythmias PULMONARY OEDEMA +n acute BCA9 ,ccumulati"n "f fluid in the alve"lar spaces results in impaired as e(chan e. <hen capillary pressure e(ceeds 2;mm/ !ulm"nary "edema results. $ta es3 ClassD +. 2" sympt"ms durin "rdinary activity. ++. $li ht limitati"n durin "rdinary activity. 0 . *ild "ccasi"nal "666666 dyspn"ea. +++. *arked limitati"n at n"rmal activity. <ith"ut sympt"ms at rest. +C. )nable t" undertake physical activity 5ith "ut sympt"ms. $ympt"ms may present at rest. Dyspn"ea "n effert & may be "nly sympt"m "f heart failure. Causes & previ"us *+ 3 vascular heart disease 3 cardi"pathy .rth"pn"ea & Dyspn"ea "n lyin flat. +ndicati"n "f m"re advance cardiac disease. hypertensi"n3 arrythmias3 atrial fibrillati"n. !ar"(ysmal n"cturnal dyspn"ea. Dyspn"ea at rest. !2D & 5ake the patient durin sleep. $evere BCA *ust be distin uished fr"m acute 7., PALPITATION Can et even bradycardia 6666666666666666666 *ay be due t" 3 A"rceful c"ntracti"n "f heart. +rre ularities "f heart rhythm Eust /' ,sk. /"5 "ften it last. !ar"(ysmal palpitati"n & 5p5 syndr"me <hether "ther sympt"ms "ccur 5ith the palpitati"n. 0 . & $ypraventricular tachycardia et p"lyuria +n hist"ry & 1he m"de "f "nset3 1he fre8uency3 666666666666666 SYNCOPE AND DIZZINESS C"uld be due t" arrythmias. Dru related Beft ventricular "utfl"5 "bstructi"ns. Cardi"vascular disease pretendin "f n"n cardiac sympt"ms . $tr"ke & Cerebral emb"lism3 0nd"carditis3 /ypertenti"n.

,bd"minal pain & Biver c"n esti"n 3 )ne(plained ri ht hyp"ch"ndriac pain 3 4aundice. ANKLE SWELLING *anifestati"n 9 9 9 9 9 9 "f "f cardiac disease. C"n estive cardiac failure & cardi"my"pathies etc. /yp"albuminaemia 2ephr"tic syndr"me / 'enal disease/ p""r nutriti"n. Cen"us insufficiency & varic"se veins. Bymphatic "bstructi"n. Cen"us "bstructi"n in perineum / abd"men 0 pre nancy3 tum"rs. o DC1 o +di"pathic edema "f 5"men

EXAMINATION OF CVS 0(aminati"n "f CC$ Airst impressi"n. *arfans syndr"me & ,"rtic re ur itati"n3 ,typical fibr"sis. 1hyr"t"(ic"sis. ,nkyl"sin sp"ndylitis9 ,"rtic re ur itati"n3 ,pical fibr"sis 1. GENERAL EXAMINATION:7reathlessness 3 in pain febile pall"r (anthesma cleft ear l"bes & ass"ciated 5ith c"r"nary artery disease. Central cyan"sis Dental care 1hyr"id enlar ement Clubbin $ta e + F9 +ncreased fluctuati"n "f nail bed $ta e ++ F9 B"ss "f an le $ta e +++ F9 +ncreased curvature $ta e+C F9 Dunstic appearance.9 7r"nchial carcin"ma +neffective end"carditis Cyan"tic heart disease.9 pe" use vibraters .slerGs n"des Eane5ays lesi"ns & infective end"carditis3 ankle edema. 2. PULSE !resence / abscense. B"5 v"lume irre ular & *ultiple v. ect"pies. B"5 v"lume la5 v"lume &BCA & ,$3 ,' F9 1hatGs 5hy ask t" e(amine pulse.

Collapsing PDA, mitral regurgitation Absent pulse Takayase disease

Rate Sinus tachycardia/ bradycardia. Rhythm Character ruits! 3. BLOOD PRESSURE 4. JVP. "e#el more than $cm. ele#ated. % $ normal&a, c, #, ', y read( 5. INSPECTION. Shape o) the chest Pectus corinatus long standing cardias disease Sugical scars *n re+ mitral stenosis . raise the brease and see. ,isible pulsation o#er pulmonary artery *n pulmonary hypertension "ocation o) ape' beat. 6. PALPATION o Ape' beat double ape' beat- ", aneurysm , ./C0 o Tapping 0S o Dyskinatic / di))use a)ter 0* o Parasternal hea#ing R,. o Palpable .S o#er the cla#icle- PDA. o Palpable murmurs- thrill- systolic/diastolic. *) cant palpate turn patient to the le)t. o *nability o) detection o) ape' beat C/PD, de'trocardia, /besity , Pericardial e))usion. 7. AUSCULTATION .eart sounds )irst and second heart sounds clearly separating in 1. intensity "e#el increase P )irst 0S P second P.T P2 so)t AS P3 so)t 0R ,aring intensity - incomplete heart block .eart murmurs /ther sounds- abnormal .S. Pericaridial rubs. /pening and closing snaps. Clicks m. #al#e prolapse .eart sounds 3, 2,%&heart )ailure( ,4 Spliting P2 is normal MURMURS I. Systolic - Pansystolic -- 0R , ,SD , TR 9 0id systolic AS, PS 9 "ate systolic 0itral #al#e prolapse

II. Di stolic 9 0id 0S/TS 9 5arly6Aortic regurgitation, PR, 9 C/7777777- PDA AS ! Systolic 0id /e8ection systolic murmur o est heard at the upper right sternal edge. .eard o#er the carotid arteries. AR 5arly diastolic "e)t sternal edge.

mid diastolic murmur in mitral area, not diagnostic o) 0S /ther6AR6asking ". rheumatic heart disease. Acute rheumatic carditis due to mitral #al#e edema o ,SD6)lo9 murmur o PDA6)lo9 murmur o Atrial my'oma

VSD Pansystolic at ler)t sternal edge. Ot"#$ C,777 /pening snaps 1 ncas77777 Prosthetic #al#e 7777777 Mit$ l % l%# &'$&'$s Auscultate 9ith bell. :i#e proper instruction to take deep 9ell breath an e'hale. Turning the patient to the le)t in e'piration AR &'$&'$s "e)t sternal edge lo9er do9n. :et patient sit )or9ard. :et diaphragm in e'piration MS 0id diastolic , R777777777, cardiac ape', "o9 pitched , best heard 9ith the bell, "e)t side in e'piration. 0ay or may not be 9ith opening snap Tapping ape' MR Parasystolic e'cept 77777777777777777777 9ith mitral #al#e prolapse in late. est heard at ape'. Conducted/ radiate to the a'illa.