1. Diagnostic Techniques Michael Del Core, M.D.

3. History Skills  History Symptoms. You need to ascertain when the problem started, what if anything brought it on, how frequently it happens, how long it lasts, what makes it better, what makes it worse and what other symptoms are associated.

4. History Skills  Symptoms –Chest pain or discomfort Chest pain or discomfortChest pain or discomfort –Dyspnea, orthopnea, paroxismal nocturnal dyspnea, wheezing, cough, hemoptysis –Peripheral findings: Edema, pain in the extremities (claudication) –Palpitations –Lightheadedness, dizziness, syncope –Fatique and weakness

5. History Skills  Chest Pain –Myocardial Ischemia –Pericardial Pain –Aortic Dissection –Pulmonary Embolism –Musculoskeletal

6. History Skills  Chest Pain –Location –Radiation –Nature –Duration –Associated symptoms

7. Physical Examination Skills  Essential Components –General appearance of the patient –Vital signs –Pulses –Jugular venous pressure –Cardiac and pulmonary examination

8. Physical Examination Skills General Appearance

10. ArterialVenous

11. Physical Examination Skills Jugular Venous Pulse

12. Cardiac Examination  S1 and S2 are valve closure sounds  S3 and S4 are ventricular sounds  Murmurs are generated whenever there is turbulent flow in the heart. Blood flow is generally laminar and uniform as it moves through the heart. Whenever there is obstruction to flow (stenotic valves) or abnormal flow (regurgitation) or high velocities (children, thyroid abnormalities, etc.) there will be turbulent flow and a murmur.  Friction rubs are caused by an inflamed pericardium that rubs against each other.

13. Cardiac Examination

15. The Electrocardiogram  The ECG (EKG) is a recording of the electrical potentials produced by cardiac tissue. These electrical potentials are what causes the fibers to contract. These electrical impulses spread throughout the body and can be recorded on the skin by applying electrodes at various points on the surface.

16. The Electrocardiogram  Conduction delay of atrial and ventricular impulses  Origin of arrhythmias  Myocardial ischemia and infarction  Atrial and ventricular hypertrophy  Pericarditis  The effect of drugs on the heart  Electrolyte balance  Function of electronic pacemakers

17. The Electrocardiogram

18. The ECG in Stress Testing

19. Stress Testing with Imaging Nuclear

20. Stress Testing with Imaging Echocardiography

21. Specialized Electrocardiographic Techniques

23. Radiology of the Heart

30. Specialized Testing  Blood Tests –Cholesterol levels –Cardiac Enzymes –CHF Peptide  Echocardiography  Cardiac Catheterization  Electrophysiologic Studies

31. Lipid Determination

32. Cardiac Enzymes

33. Specialized Testing  Blood Tests –Cholesterol levels –Cardiac Enzymes –CHF Peptide  Echocardiography  Cardiac Catheterization  Electrophysiologic Studies

34. Echocardiography

35. Echocardiography

36. Echocardiography

37. Echocardiography

38. Doppler Echocardiography

40. Specialized Testing  Blood Tests –Cholesterol levels –Cardiac Enzymes –CHF Peptide  Echocardiography  Cardiac Catheterization  Electrophysiologic Studies

41. Cardiac Catheterization

49. Specialized Testing  Blood Tests –Cholesterol levels –Cardiac Enzymes –CHF Peptide  Echocardiography  Cardiac Catheterization  Electrophysiologic Studies

50. Electrophysiology Testing  Measurements of cardiac electrical activation and conduction  Induction and termination of arrhythmias (with programmed electrical stimulation)  Assessment of risk for malignant arrhythmias and sudden cardiac death  Treatment with ablation  Assessment of the effects of drug and electric interventions, including device and ablative therapies

51. Electrophysiology