2. Dyspnoea – Dyspnoea Is An Abnormal Awareness Of Breathing Occurring Either At Rest Or An Unexpectedly Low Level Of Exertion.
Orthopnoea – In Patient With Heart Failure Lying Flat Causes A Steep Rise In Left Atrial Pressure, Resulting In Pulmonary Congestion And Severe Dyspnoea.
PND – Frank Pulmonary Oedema On Lying Flat Wakes The Patient From Sleep With Distressing Dyspnoea And Fear Of Imminent Death. The Symptoms Are Corrected By Standing Upright.
3. Chest Pain
4. Palpitation– Awareness Of The Heart Beat.
5. Dizziness And Syncope; Black- Out
6. Swelling Of Feet Or Facial Puffiness
Scheme Of Examination
Rate & Rhythm: Assessed By Palpating The Right Radial Pulse
Volume: Evaluated At Right Carotid Artery
Condition Of The Arterial Wall
Comparison between 2 Radial Pulses
Examination Of Neck Veins –
Engorged Or Not
Pulsation- Present Or Not
Hepatojugular Reflux- Present Or Not
Examination Of The Heart–
Inside The Precordium
Engorged Superficial Veins
Polythelia ( Accessory Nipple )
Any Scar Mark, Sinuses
Outside The Precordium-
Any Pulsation Present In- Aortic Area, Pulmonary Area, Right & Left Parasternal Areas, Epigastrium, Suprasternal Area, Carotid Areas, Back esp. At The Inferior Angle Of Scapula In Coarctation Of Aorta (Suzman’s Sign)
Back – For Scoliosis, Kyphosis, Gibbus, Drooping Of Shoulder, Winging Of Scapula, Skin ( For Sinus, Ulcer, Venous Or Arterial Prominence, Scar Mark).
Apex Beat – Site [ Left 5th Inter Costal Space, ½ “ inside the left mid-clavicular line ] & Character
Palpable Heart Sound (M₁)
Pulmonary Area [ the Left 2nd Inter Costal Space (close to the sternum )]
Palpable Heart Sound (P₂)
Aortic Area [ the Right 2nd Inter Costal Space(close to the sternum)]
Palpable Heart Sound (A₂)
Tricuspid Area[the Left 4th Inter Costal Space(close to the sternum )]
Palpable Heart Sound (T₁)
Direction Of Venous Blood Flow (In Engorged Superficial Veins )
Thrill In Carotid Arteries ( Carotid Shudder )
Epigastric Or Suprasternal Pulsation, Or Any Pulsation Over The Neck
Palpable Pericardial Rub
Percussion – NOT DONE
Auscultation [Sequence: 1. APEX 2. TA 3. NA 4. PA 5. AA]
Adventitious Sound- Opening Snap, Ejection Click, Splitting Of Heart Sound, S₃ Or S₄
Neoaortic Area [The Left 3rd Inter Costal Space (Close To The Sternum )]
Carotid Arteries For Bruit ( After Holding The Breath )
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