Cardiology Core Curriculum A problem-based approach - part 1 potx

[...].. .Cardiology Core Curriculum Christina Karaviotis, Lotika Singha and Andy Baker of BMJ Books for their advice, support, and the rapid response to trans-Atlantic emails and attachments For administrative support I remain indebted to Shirley Crook and Doris Matthews John D Rutherford UT Southwestern Medical Center Dallas, Texas xii Cardiology Core Curriculum Table 1. 1 Severity of angina (Canadian Cardiovascular... mitral valve apparatus The clinical examination features associated with an immobile mitral valve apparatus when the patient has atrial fibrillation, pulmonary hypertension, and secondary tricuspid regurgitation are as follows In addition to symptoms of breathlessness and palpitations, the patient may complain of reduced energy and leg swelling On physical examination the patient may appear normal or... hypertrophy, atrial premature beats, or P-wave abnormalities of mitral valve disease may represent substrates for atrial fibrillation; Q waves of prior myocardial infarction may be the substrate for ventricular arrhythmias; and a long QT interval is possibly associated with polymorphic ventricular tachycardia.2) Shortness of breath, or dyspnea, is a normal accompaniment of physical exertion and is accentuated... heard as a “plateau” Murmurs associated with the aortic and pulmonary valves are usually best heard at the base of the heart, those associated with the mitral valve are best heard at the apex, and those associated with the tricuspid valve at the lower left sternal edge In general, right sided heart murmurs are accentuated by inspiration, aortic diastolic murmurs are best heard with the patient leaning... of normal rhythm and the rhythm associated with their symptoms (A 12 -lead electrocardiogram taken during the abnormal rhythm can be diagnostic An electrocardiogram taken in normal sinus rhythm can give clues as to the possible primary diagnosis For 2 Cardiac history and examination example, a short PR interval and δ waves suggest pre-excitation and supraventricular tachycardia; left ventricular hypertrophy,... intracranial pressure seen as papilledema, usually associated with retinal exudates and hemorrhages (grade 4 changes) Grade 2 changes correlate with other evidence of clinical cardiovascular disease or endorgan damage (left ventricular hypertrophy, renal disease, arterial disease) Overall risk in patients with hypertension correlates with presence, or absence, of conventional cardiovascular risk factors... holosystolic murmur is heard and may be accompanied by an S3 The chest and abdominal examinations are normal There is no peripheral edema Electrocardiogram findings are left ventricular hypertrophy, ST and T wave abnormalities, and prominent septal Q 21 Cardiology Core Curriculum Table 1. 4 Distinguishing examination features of obstructive hypertrophic cardiomyopathy and aortic valve stenosis Feature Pulse Murmur... congestion Abdominal examination indicates increased liver span and a pulsatile liver Peripheral edema is present Electrocardiogram findings are atrial fibrillation, evidence of right ventricular hypertrophy with a rightward shift of the mean frontal plane axis greater than 80°, and an R : S ratio greater than 1 0 in V1 The chest x ray film may show left atrial enlargement, evidence of pulmonary congestion,... lines, and enlargement of the pulmonary arteries and right ventricle Aortic stenosis Aortic valve stenosis seen in adults is usually secondary to a congenital bicuspid valve or age-related degenerative calcification and 18 Cardiac history and examination P2 loud Base S1 S2 S1 Holosystolic murmur increases with inspiration LSE Apex MDM S1 variable Figure 1. 4 Mitral stenosis, pulmonary hypertension, and... may indicate involvement of the great arteries leaving the heart, in a disease process (arterial occlusive disease, aortic dissection or coarctation) The major arterial pulses (carotid, brachial, radial, femoral, popliteal, posterior tibial, and dorsalis pedis) should be examined bilaterally Diminished or absent arterial pulses suggest occlusive disease The radial and femoral arteries should be palpated .