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Ebook Harrison's manual of medicine (16th edition): Part 2

(BQ) Part 2 book "Harrison's manual of medicine" presents the following contents: Cardiovascular diseases, respiratory diseases, renal diseases, gastrointestinal diseases; allergy, clinical immunology, and rheumatology; endocrinology and metabolism; neurology; psychiatric disorders and psychoactive substance use; adverse drug reactions; women’s health,. and other contents. | SECTION 8 CARDIOVASCULAR DISEASES 117 PHYSICAL EXAMINATION OF THE HEART General examination of a pt with suspected heart disease should include vital signs respiratory rate pulse blood pressure skin color clubbing edema evidence of decreased perfusion cool and sweaty skin and hypertensive changes in optic fundi. Important findings on cardiovascular examination include CAROTID ARTERY PULSE Fig. 117-1 Pulsus parvus Weak upstroke due to decreased stroke volume hypovolemia LV failure aortic or mitral stenosis . Pulsus tardus Delayed upstroke aortic stenosis . Bounding hyperkinetic pulse Hyperkinetic circulation aortic regurgitation patent ductus arteriosus marked vasodilatation. Pulsus bisferiens Double systolic pulsation in aortic regurgitation hypertrophic cardiomyopathy. Pulsus alternans Regular alteration in pulse pressure amplitude severe LV dysfunction . Pulsus paradoxus Exaggerated inspiratory fall 10 mmHg in systolic bp pericardial tamponade severe obstructive lung disease . JUGULAR VENOUS PULSATION JVP Jugular venous distention develops in right-sided heart failure constrictive pericarditis pericardial tamponade obstruction of superior vena cava. JVP normally falls with inspiration but may rise Kussmaul s sign in constrictive pericarditis. Abnormalities in examination include Large a wave Tricuspid stenosis TS pulmonic stenosis AV dissociation right atrium contracts against closed tricuspid valve . Large v wave Tricuspid regurgitation atrial septal defect. Steep y descent Constrictive pericarditis. Slow y descent Tricuspid stenosis. PRECORDIAL PALPATION Cardiac apical impulse is normally localized in the fifth intercostal space midclavicular line Fig. 117-2 . Abnormalities A. Hypokinetic Pulse B. Parvus et Tardus Pulse C. Hyperkinetic Pulse D. Bisferiens Pulse E. Dicrotic Pulse Alternans FIGURE 117-1 Carotid artery pulse patterns. 593 Copyright 2005 2002 1998 1995 1991 1988 by The McGraw-Hill Companies Inc. Click here for terms of use. 594 SECTION 8 .