A- 20-y.

o woman came to primary clinic with history of syncope and

shortness of breath, she had arthralgia and fever when she was a child.

Additional anamnesis ?

Physical Examination
Additional anamnesis:
• History of sore throat in childhood
• DD+, OP+, PND +
• Cronic cough sometimes with bloody sputum
• 7 days ago she notice that her leg became bigger
• She routinely consume drugs for her previous
stroke history
• She notice of increasing body weigth within thin
week
Additional physical examination:
• Vital sign : BP: 90/60 mmHg, pulse: 70 bpm, RR:
32x/mnt, t: 36,4C, BW: 45 kg, Height:155 cm
• Inspection:
üMalar rash+, epigastic pulsation +
• Palpasion:
üElevated JVP 5-4 cmH2O
üHeaving at left parasternal border
üPalpable pulsation at epigastric
üEdeme lower extremities
• Auscultation
üOpening snap
üLoud S1
ülow pitched mid-diastolic murmur (rumbling)
A- 50-y.o man came to primary clinic with chest pain when he did strenous
activity and shortness of breath, he has no cardiovascular risk factor.

Additional anamnesis ?
Physical Examination
Additional anamnesis:
• He often feel nearly sinkope when he is doing
vigorous activity
• Fatigue especially during increased activity
• He has no history of rheumatic fever
Additional physical examination:
• Vital sign : BP: 90/60 mmHg, pulse: 75 bpm, RR:
20x/mnt, t: 36,4C, BW: 45 kg, Height:155 cm
• Inspection:
üWithin normal limit
• Palpasion:
üJVP 5+3 cmH2O
• Weak and delayed arterial pulses with carotid thrill
• Auscultation
üEjection systolic murmur > grade 3/6
A- 40-y.o women came to hospital with shortness of breath, leg edema and
inability to sleep in supine position, she has history of CAD.

Additional anamnesis ?
Physical Examination
Additional anamnesis:
• DD+, OP+, PND +
• Cronic cough sometimes with froty sputum
• She notice increasing of her body weigth within this
week
• She didnt routinely consume drugs for her CAD
history
Additional physical examination:
• Vital sign : BP: 90/60 mmHg, pulse: 90 bpm, RR:
34x/mnt, t: 36,4C, BW: 57 kg, Height:155 cm
• Inspection:
üLeg edema
• Palpasion:
üElevated JVP 5+4 cmH2O
üIctus cordis moved laterally down ward
üLeft heart enlargment
üEdema lower extremities
• Auscultation
üPansystolic murmur at apex
A- 30-y.o man came to hospital with shortness of breath, he was told previosly
of having a valve disorder of the heart

Additional anamnesis ?
Physical Examination
Additional anamnesis:
• he feels palpitation
• DD+, OP+, PND +
• Nocturnal angina+
Additional physical examination:
• Vital sign : BP: 120/50 mmHg, pulse: 92 bpm, RR:
24x/mnt, t: 36,4C, BW: 50 kg, Height:155 cm
• Inspection:
üHead nodding+
üMeuler sign +
• Palpasion:
üElevated JVP 5+4 cmH2O
üQuinck’s sign +
üCorrigan’s sign/ water hamer sign +
• Auscultation
üTraub’s sign +
üAustin flint murmur at the apex +
üblowing diastolic murmur at the base