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.
Chapter 1. Approach to the Physical Examination of the Cardiac Patient Reasons for Which Cardiac Assessment Is Sought Cardiac Symptoms and Their Appraisal Generation of Working List of Possible Diagnoses Focused Physical Examination: Clinical Exercise Focused Physical Examination: Practical Points Chapter 2. Arterial Pulse Physiology of the Arterial Pulse Assessment of the Arterial Pulse Practical Points in the Clinical Assessment of the Arterial Pulse References Chapter 3. Blood Pressure and Its Measurement Physiology of Blood Flow and Blood Pressure Physiology of Blood Pressure Measuremen Points to Remember When Measuring Blood Pressure Factors That Affect Blood Pressure Readings Interpretation of Blood Pressure Measurements Use of Blood Pressure Measurement in Special Clinical Situations References Chapter 4. Jugular Venous Pulse Normal Right Atrial Pressure Pulse Contours Jugular Venous Inflow Velocity Patterns and the Relationship to the Right Atrial Pressure Pulse Jugular Venous Flow Events and Their Relationship to Jugular Venous Pulse Contours Normal Jugular Venous Pulse Contour and Its Recognition at the Bedside Individual Components of the Right Atrial Pressure Pulse, Their Determinants, and Their Recognition in the Jugulars Abnormal Jugular Venous Pulse Contours as Related to Abnormal Jugular Venous Flow Velocity Patterns Abnormal Jugular Contours Assessment of Jugular Venous Pressure Clinical Assessment of the Jugular Venous Pulse References Chapter 5. Precordial Pulsations Mechanics and Physiology of the Normal Apical Impulse Physical Principles Governing the Formation of the Apical Impulse Normal Apical Impulse and Its Determinants Assessment of the Apical Impulse Left Parasternal and Sternal Movements Right Parasternal Movement Pulsations Over the Clavicular Heads Pulsations Over the Second and/or Third Left Intercostal Spaces Subxiphoid Impulse Practical Points in the Clinical Assessment of Precordial Pulsations References Chapter 6. Heart Sounds Principles of Sound Formation in the Heart First Heart Sound (S1) Clinical Assessment of S1 and Components Second Heart Sound (S2) Normal S2 Abnormal S2 Clinical Assessment of S2 Opening Snap (OS) Third Heart Sound (S3) Clinical Assessment of S3 Fourth Heart Sound (S4) Clinical Assessment of S4 References Chapter 7. Heart Murmurs: Part I Principles Governing Murmur Formation Hemodynamic Factors and Cardiac Murmurs Frequencies of Murmurs Grading of Murmurs Systolic Murmurs Ejection Murmurs Regurgitant Systolic Murmurs Mitral Regurgitation Tricuspid Regurgitation Ventricular Septal Defect (VSD) Clinical Assessment of Systolic Murmurs References Chapter 8. Heart Murmurs: Part II Diastolic Murmurs Diastolic Murmurs of Mitral Origin Diastolic Murmurs of Tricuspid Origin Semilunar Valve Regurgitation Aortic Regurgitation Pulmonary Regurgitation Clinical Assessment of Diastolic Murmurs Continuous Murmurs Persistent Ductus Arteriosus Aorto-Pulmonary Window Sinus of Valsalva Aneurysm Coronary Arteriovenous Fistulae Venous Hum Mammary Souffle Clinical Assessment of Continuous Murmurs Pericardial Friction Rub Innocent Murmurs References Chapter 9. Elements of Auscultation The Stethoscope Auscultation Method References Chapter 10. Pathophysiological Basis of Symptoms and Signs in Cardiac Disease Pathophysiology of Mitral Regurgitation Pathophysiology of Aortic Regurgitation Pathophysiology of Mitral Stenosis Pathophysiology of Aortic Stenosis Pathophysiology of Myocardial Ischemia/Infarction Pathophysiology of Hypertensive Heart Disease Pathophysiology of Dilated Cardiomyopathy Pathophysiology of Hypertrophic Obstructive Cardiomyopathy Pathophysiology of Atrial Septal Defect Pathophysiology of Diastolic Dysfunction Pathophysiology of Constrictive Pericarditis Pathophysiology of Cardiac Tamponade Appendix References Chapter 11. Local and Systemic Manifestation of Cardiovascular Disease General Observations Congenital Syndromes/Diseases Vascular Diseases Valvular Heart Disease Endocrine and Metabolic Diseases Inflammatory Diseases Diseases of Connective Tissue and Joints Drug Therapy Musculoskeletal Diseases Tumors Synopsis Index