1. Cardiac History & Examination
Jamil Mayet
Consultant Cardiologist
St Mary’s Hospital

2. Chest Pain Character Radiation Relation with inspiration Provocation
Grading
Canadian Cardiovascular Society
I - Ordinary activity does not provoke
II - Slight limitation of ordinary activity
III - Marked limitation of ordinary activity (<1 flight steps)
IV – Inability to carry out physical activity

3. Dyspnoea Exertional Orthopnoea Paroxysmal nocturnal dyspnoea
NYHA Classification
I - No SOB
II - SOB on severe exertion
III - SOB on mild exertion
IV – SOB at rest

4. Other Symptoms Palpitations Syncope Fatigue Oedema Regular / irregular
Fast / slow
Extra beats
Syncope
Usually sudden and brief if cardiac cause
“Stokes-Adams” attacks
Fatigue
Oedema

5. General examination Comfort / distress / resp rate Scars
Bruising / needle marks
Chest wall motions
JVP / ankle oedema
IV infusions
Diabetic food / drinks
KEEP YOUR EYES OPEN

6. Hands Clubbing Peripheral stigmata of endocarditis Peripheral cyanosis
Cyanotic Congenital Heart Disease
Bacterial Endocarditis
Peripheral stigmata of endocarditis
Splinter haemorrhages
Osler nodes
Janeway lesions
Peripheral cyanosis
Cardiac / Respiratory / Vasoconstriction

7. Pulse
Radial
Rate
Rhythm
Volume
(Character)

8. Pulse

9. Blood Pressure Appropriate cuff size Palpate first Slowly deflate
Korotkoff V

10. Eyes and mouth Anaemia Jaundice Xanthelesma Corneal arcus
Central cyanosis

11. Carotid pulse

12. Jugular Venous Pressure

13. Jugular Venous Pressure
A wave – atrial systole
X descent – end of atrial systole
C wave – transmission of rapidly increasing RV pressure just before TV closes
V wave – venous return to RA during ventricular systole
Y descent – TV opening

14. Jugular Venous Pressure
Large a waves
Pulm ht, pulm stenosis, tricuspid stenosis
Cannon a waves
A wave against closed TV
CHB, VT, Junctional rhythm
Giant v waves
Tricuspid regurgitation

15. Praecordium

16. Praecordium

17. Auscultation
Apex
LSE
Pulm
Aortic
1st sound
2nd sound
Systole
Diastole

18. Auscultation Radiation of murmurs Left side with bell at apex
Sat forward in expiration

19. Murmurs Systolic Diastolic Ejection Pan systolic Early Mid
Aortic, (pulmonary), flow murmurs
Pan systolic
MR, (TR), (VSD)
Diastolic
Early
AR, (PR)
Mid
MS, (TS)

20. Peripheral pulses