Approach to cardiovascular

disease

Dr. LIU LIXIN

General examination
 Vital signs: respiratory rate
,pulse,blood pressure
 Skin color :cyanosis
 Clubbing :anoxia
 Edema
 Evidence of decreased perfusion:
cool,sweaty skin
 Hypertensive changes
 Important findings on
cardiovascular
examination
Carotid artery pulse
 Pulsus parvus:stroke volume ↓
 Pulsus tardus:delay upstroke,AS
 Bounding pulse:hyperkinetic
circulation,AR
 Pulsus bisferiens:double systolic
pulsation,AR,HCM
 Pulsus alternan:LV dysfunction
 Pulsus paradoxus:cardiac tamponade
,COPD
Jugular venous pulsation
 Position: the patient supine with the
head of the table elevated 30 degrees
 Use tangential, side lighting to observe
for venous pulsations in the neck
 Look for a rapid, double (sometimes
triple) wave with each heart beat. Use
light pressure just above the sternal end
of the clavicle to eliminate the
pulsations and rule out a carotid origin
Precordial palpation
 Left ventricular thrust : Left ventricular
hypertrophy
 Displacement of left ventricular pulse
downward and to the left: Left
ventricular dilatation; left ventricular
failure; volume overload (aortic
regurgitation or decompen- sated mitral
regurgitation)
 Presystolic impulse: Pressure
overloaded states (hypertension, aortic
Precordial palpation
 Double systolic impulse:Hypertrophic
obstructive cardiomyopathy
 Systolic bulge (dyskinetic impulse):Coronary
artery disease, recent myocardial infarction
(most commonly felt above and medial to the
point of maximal impulse)
 Parasternal lift:Mitral regurgitation (occurs
after the left ventricular apical impulse); right
ventricular dilatation (mitral stenosis,
pulmonary embolism)
 Thrills:Aortic stenosis, pulmonic stenosis;
ventricular septal defect, severe mitral
regurgitation
Auscultation:heart sounds
 S1 loud:MS,short PR
interval,hyperkinetic heart,think chest
wall
 S1 soft :long PR interval,heart
failure,MR,PE,thick chest wall
 A2↑: hypertension
P2 ↑: pulmonary hypertension in MS, MI
A2↓: AS ,AI
P2 ↓: PS, PI
Heart Murmurs
1. When does it occur - systole or diastole
2. Where is it loudest - A, P, T, M
I. Systolic Murmurs:
1. Aortic stenosis - ejection type
2. Mitral regurgitation - holosystolic
3. Mitral valve prolapse - late systole

II. Diastolic Murmurs:

1. Aortic regurgitation - early diastole
2. Mitral stenosis - mid to late diastole
Heart Murmurs
A. Presystolic murmur
 Mitral/Tricuspid stenosis

B. Mitral/Tricuspid regurg.
C. Aortic ejection murmur
D. Pulmonic stenosis (spilling
through S20
E. Aortic/Pulm. diastolic
murmur
F. Mitral stenosis w/ Opening
snap
G. Mid-diastolic inflow murmur
H. Continuous murmur of PDA
Diagnostic Testing
 Noninvasive Testing:
chest X-ray, ECG,Treadmill, Echo,
MRI,Blood test(myocardial
enzyme )
 Invasive Testing:
Cardiac catheterization and
Angiography
Chest X -Ray
 This test is done to find the cause
of symptoms such as shortness of
breath, chest pain, chronic cough,
and fever.
 help doctors diagnose conditions
such as pneumonia, heart failure,
lung cancer, pericardial effusion
Electrocardiogram
 ECG, is a simple, painless test that
records the heart's electrical
activity
 ECG is used to detect and evaluate
many heart problems, such as
coronary heart disease , AMI,
arrhythmia and heart failure.
 Echocardiography
 Echo is a painless test that uses
sound waves to create images of
heart.
• The size of heart: An enlarged
heart can be the result of
high blood pressure, leaky heart
valves, or heart failure.
• Problems with heart’s valves:the
valves of heart don’t open
 Echocardiography
• Heart muscles that are weak and
aren’t moving (pumping) properly.
Weakened areas of heart muscle
can be due to damage from a
heart attack. Or weakening could
mean that the area isn’t getting
enough blood supply, which can be
due to coronary artery disease.
Echocardiography
• Abnormalities in the structure of heart:
detect a variety of heart abnormalities,
such as a hole in the septum and other
congenital heart defects (structural
problems present at birth).
• The aorta. Echo is commonly used to
assess and detect problems with the
aorta such as aneurysm, aortic
dissection
• Blood clots or tumors.
Cardiac MRI
 Magnetic resonance imaging (MRI)
is a safe, noninvasive test that
creates detailed images of your
organs and tissues.
 Cardiac MRI is a common test for
diagnosing and evaluating a
number of diseases and conditions,
including:
Cardiac MRI
 Coronary artery disease
 Damage caused by a heart attack
 Heart failure
 Heart valve problems
 Congenital heart defects
 Pericardial disease
 Cardiac tumors
Coronary Angiography

 a test that uses contrast agent and

special x rays to show the inside of
your coronary arteries.
 the gold standard for coronary
arteries diaease diagnosis.
 Right heart catheterization
 Left heart catheterization
Regional anatomy relevant to percutaneous
femoral arterial and venous catheterization
 Modified Seldinger technique for
percutaneous catheter sheath introduction
圖三 冠狀動脈支架使用示意圖