Available:*
Library | Item Barcode | Call Number | Material Type | Item Category 1 | Status |
---|---|---|---|---|---|
Searching... | 30000010150431 | RC683 R36 2006 | Open Access Book | Book | Searching... |
Searching... | 30000010150432 | RC683 R36 2006 | Open Access Book | Book | Searching... |
On Order
Summary
Summary
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).
Table of Contents
Preface | p. vii |
Acknowledgment | p. x |
Companion CD | p. xv |
Color Plates | p. xvii |
Chapter 1 Approach to the Physical Examination of the Cardiac Patient | p. 1 |
Reasons for Which Cardiac Assessment Is Sought | p. 2 |
Cardiac Symptoms and Their Appraisal | p. 2 |
Generation of Working List of Possible Diagnoses | p. 4 |
Focused Physical Examination: Clinical Exercise | p. 6 |
Focused Physical Examination: Practical Points | p. 14 |
Chapter 2 Arterial Pulse | p. 15 |
Physiology of the Arterial Pulse | p. 15 |
Assessment of the Arterial Pulse | p. 34 |
Practical Points in the Clinical Assessment of the Arterial Pulse | p. 44 |
References | p. 46 |
Chapter 3 Blood Pressure and its Measurement | p. 49 |
Physiology of Blood Flow and Blood Pressure | p. 49 |
Physiology of Blood Pressure Measurement | p. 50 |
Points to Remember When Measuring Blood Pressure | p. 52 |
Factors That Affect Blood Pressure Readings | p. 53 |
Interpretation of Blood Pressure Measurements | p. 54 |
Use of Blood Pressure Measurement in Special Clinical Situations | p. 56 |
References | p. 64 |
Chapter 4 Jugular Venous Pulse | p. 67 |
Normal Right Atrial Pressure Pulse Contours | p. 68 |
Jugular Venous Inflow Velocity Patterns and the Relationship to the Right Atrial Pressure Pulse | p. 70 |
Jugular Venous Flow Events and Their Relationship to Jugular Venous Pulse Contours | p. 74 |
Normal Jugular Venous Pulse Contour and Its Recognition at the Bedside | p. 81 |
Individual Components of the Right Atrial Pressure Pulse, Their Determinants, and Their Recognition in the Jugulars | p. 82 |
Abnormal Jugular Venous Pulse Contours as Related to Abnormal Jugular Venous Flow Velocity Patterns | p. 92 |
Abnormal Jugular Contours | p. 96 |
Assessment of Jugular Venous Pressure | p. 105 |
Clinical Assessment of the Jugular Venous Pulse | p. 107 |
References | p. 110 |
Chapter 5 Precordial Pulsations | p. 113 |
Mechanics and Physiology of the Normal Apical Impulse | p. 113 |
Physical Principles Governing the Formation of the Apical Impulse | p. 115 |
Normal Apical Impulse and Its Determinants | p. 118 |
Assessment of the Apical Impulse | p. 120 |
Left Parasternal and Sternal Movements | p. 133 |
Right Parasternal Movement | p. 134 |
Pulsations Over the Clavicular Heads | p. 134 |
Pulsations Over the Second and/or Third Left Intercostal Spaces | p. 135 |
Subxiphoid Impulse | p. 135 |
Practical Points in the Clinical Assessment of Precordial Pulsations | p. 136 |
References | p. 138 |
Chapter 6 Heart Sounds | p. 141 |
Principles of Sound Formation in the Heart | p. 141 |
First Heart Sound (S1) | p. 142 |
Clinical Assessment of S1 and Components | p. 156 |
Second Heart Sound (S2) | p. 158 |
Normal S2 | p. 159 |
Abnormal S2 | p. 162 |
Clinical Assessment of S2 | p. 174 |
Opening Snap (OS) | p. 179 |
Third Heart Sound (S3) | p. 185 |
Clinical Assessment of S3 | p. 198 |
Fourth Heart Sound (S4) | p. 200 |
Clinical Assessment of S4 | p. 204 |
References | p. 206 |
Chapter 7 Heart Murmurs: Part I | p. 211 |
Principles Governing Murmur Formation | p. 211 |
Hemodynamic Factors and Cardiac Murmurs | p. 214 |
Frequencies of Murmurs | p. 214 |
Grading of Murmurs | p. 216 |
Systolic Murmurs | p. 216 |
Ejection Murmurs | p. 217 |
Regurgitant Systolic Murmurs | p. 232 |
Mitral Regurgitation | p. 233 |
Tricuspid Regurgitation | p. 253 |
Ventricular Septal Defect (VSD) | p. 258 |
Clinical Assessment of Systolic Murmurs | p. 265 |
References | p. 269 |
Chapter 8 Heart Murmurs: Part II | p. 275 |
Diastolic Murmurs | p. 275 |
Diastolic Murmurs of Mitral Origin | p. 275 |
Diastolic Murmurs of Tricuspid Origin | p. 282 |
Semilunar Valve Regurgitation | p. 283 |
Aortic Regurgitation | p. 283 |
Pulmonary Regurgitation | p. 290 |
Clinical Assessment of Diastolic Murmurs | p. 292 |
Continuous Murmurs | p. 294 |
Persistent Ductus Arteriosus | p. 296 |
Aorto-Pulmonary Window | p. 298 |
Sinus of Valsalva Aneurysm | p. 298 |
Coronary Arteriovenous Fistulae | p. 299 |
Venous Hum | p. 300 |
Mammary Souffle | p. 300 |
Clinical Assessment of Continuous Murmurs | p. 300 |
Pericardial Friction Rub | p. 302 |
Innocent Murmurs | p. 303 |
References | p. 304 |
Chapter 9 Elements of Auscultation | p. 309 |
The Stethoscope | p. 309 |
Auscultation Method | p. 310 |
References | p. 318 |
Chapter 10 Pathophysiological Basis of Symptoms and Signs in Cardiac Disease | p. 321 |
Pathophysiology of Mitral Regurgitation | p. 321 |
Pathophysiology of Aortic Regurgitation | p. 325 |
Pathophysiology of Mitral Stenosis | p. 329 |
Pathophysiology of Aortic Stenosis | p. 331 |
Pathophysiology of Myocardial Ischemia/Infarction | p. 334 |
Pathophysiology of Hypertensive Heart Disease | p. 336 |
Pathophysiology of Dilated Cardiomyopathy | p. 338 |
Pathophysiology of Hypertrophic Obstructive Cardiomyopathy | p. 340 |
Pathophysiology of Atrial Septal Defect | p. 342 |
Pathophysiology of Diastolic Dysfunction | p. 345 |
Pathophysiology of Constrictive Pericarditis | p. 347 |
Pathophysiology of Cardiac Tamponade | p. 348 |
Appendix | p. 351 |
References | p. 356 |
Chapter 11 Local and Systemic Manifestations of Cardiovascular Disease | p. 361 |
General Observations | p. 361 |
Congenital Syndromes/Diseases | p. 364 |
Vascular Diseases | p. 369 |
Valvular Heart Disease | p. 372 |
Endocrine and Metabolic Diseases | p. 373 |
Inflammatory Diseases | p. 377 |
Diseases of Connective Tissue and Joints | p. 377 |
Pharmacological Agents | p. 381 |
Musculoskeletal Diseases | p. 384 |
Tumors | p. 386 |
Synopsis | p. 386 |
Acknowledgment | p. 390 |
References | p. 390 |
Index | p. 397 |
About the Authors | p. 413 |