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How to Examine the Heart

How to Examine the Heart. Introduction and Inspection. How to Examine the Heart. Examine the heart from peripheral to central putting the pieces of the puzzle together as you go By the time you put the stethoscope on the chest you should know what you will hear

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How to Examine the Heart

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  1. How to Examine the Heart Introduction and Inspection

  2. How to Examine the Heart • Examine the heart from peripheral to central putting the pieces of the puzzle together as you go • By the time you put the stethoscope on the chest you should know what you will hear • Don’t leave the bedside and then try to figure out what you’ve heard. Be certain before the exam is over.

  3. Inspection Look for clues to the diagnosis

  4. Inspection • Go with the probabilities • Long thin people have long thin valves (MVP) • Males more likely to have aortic valve disease • Young-think bicuspid aortic valve • Middle age-think rheumatic AV disease • Elderly -think degenerative AV disease • Females- think mitral valve disease • MVP much more common than rheumatic MV disease

  5. Down syndrome trisomy 21 VSD Turner syndrome – Partialdeletion or absence of X chromosome gonadal dysgenesis aortic coarctation bicuspid aortic valve aortic dissection Noonan’s syndrome Dysmophic feature-short stature,webbed neck Pulmonary stenosis Hypertrophic cardiomyopathy Marfan syndrome Myotonic Dystrophy Inspection Identify specific syndromes

  6. MARFAN Syndromehttp://www.io.com/~cortese/marfan/photographs used with permission Body Habitus • Tall/thin/long facies • Long fingers • Thumb sign • Wrist sign • Ligamentous laxity • Scoliosis/kyphosis • Pectus excavatum/carinatum • Ectopia lentis • Narrow long facies • High arched palate

  7. Habitus Tall/thin/long facies Long fingers Thumb sign Wrist sign Ligamentous laxity Scoliosis/kyphosis Pectus excavatum/carinatum Ectopia lentis Aortic dissection Dilatation of the aorta affecting sinuses of valsalva MVP Mitral regurgitation LV dilatation Dilated pulmonary artery < age 40 MAC < age 40 Marfan’s Syndrome

  8. Long fingersLigamentous laxity

  9. Ectopia Lentis in Marfan Syndrome

  10. Myotonic Dystrophy • Autosomal dominant /variable penetrance • Myotonia • Wasting /weakness facial and distal muscles • Frontal balding • Cataracts • Cardiomyopathy • Conduction defects • Low intelligence or dementia

  11. Inspection • Clubbing • Cyanosis • Xanthoma and xanthelasma • Arcus • Pectus excavatum

  12. Differential Diagnosis of Clubbing • Cyanotic congenital heart disease • Lung disease • Cystic fibrosis • Interstitial fibrosis • Malignancy • Sarcoidosis • Bronchiectasis • Hyperthyroidism

  13. Arcus senilis (juvenilis) Arcus juvenilis. This ring is associated with premature atherosclerosis

  14. Xanthelasma

  15. Xanthoma • Nodular protuberance of the extensor surface of the leg (left panel) as well as multiple nodules of the arm (right panel)

  16. Eruptive xanthoma • Bulbous cutaneouseruptions associated with hyperlipidemia

  17. Pigmentation due to amiodarone

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