Académique Documents
Professionnel Documents
Culture Documents
Heart Murmurs
Conduction
system
SA node
AV node
Bundle of His
Bundle branches
Purkinje fibers
Arterial pressure
Factors influencing arterial pressure
Left ventricular stroke volume
Distensibility of the aorta and the large arteries
Peripheral vascular resistance, particularly at
the arteriolar level
Volume of blood in the arterial system
Palpitations
Heart skipping, racing, fluttering, pounding
Shortness of Breath
Dyspnea, orthopnea, paroxysmal nocturnal
dyspnea
Edema
Dependent edema, congestive heart disease,
hypoalbuminemia
Nocturia
Dependent edema, clears at night when patient
supine
Cyanosis or pallor
Poor oxygenation of body
Past History
Heart problems?
Heart disease?
Murmurs?
Congenital heart disease/defect?
Rheumatic fever?
Hypertension?
Elevated cholesterol or triglycerides?
Diabetes?
Family History
Lifestyle Habits
Nutrition
Smoking
Alcohol
Exercise
Medications, over-the-counter drugs,
herbs, nutritional supplements
Physical Examination
Preparation of the patient
Comfortable and calm
Explain procedure
Examination gown (opened in the front)
Assist to examining table
Cover with drape
Perform examination from patients right side
Physical Examination
(contd)
Equipment
Stethoscope with a bell and diaphragm
Sphygmomanometer
Two 15-cm rulers
Watch with second hand
Examination light for tangential lighting
Physical Examination
(contd)
Face
Color: cyanosis, pallor
Orbital edema
Anxiety: occurs during myocardial infarctions
Physical Examination
(contd)
Physical Examination
(contd)
Brachial artery
Physical Examination
(contd)
Physical Examination
(contd)
Physical Examination
(contd)
Hepatojugular reflux
If heart failure is present, jugular
venous pressure will remain
elevated.
Physical Examination
(contd)
The heart
Positioning patient
Supine
Turning to left side
Sitting and leaning forward
Physical Examination
(contd)
Physical Examination
(contd)
Apical Pulse
Physical Examination
(contd)
Apical pulse
(contd)
Location
Diameter
Physical Examination
(contd)
Physical Examination
(contd)
Physical Examination
(contd)
The heart (contd)
Auscultation
Overview
Know your stethoscope
Physical Examination
(contd)
Physical Examination
(contd)
Physical Examination
(contd)
Physical Examination
(contd)
Physical Examination
(contd)
Peripheral edema
Inspect feet, ankles, and legs.
May indicate heart failure
To be covered in detail in Chapter 15
Health Promotion
Topics
Coronary heart disease
Stroke prevention
Hypertension prevention and management
Hyperlipidemia prevention and
management
Health Promotion
(contd)
Health Promotion
(contd)
Health Promotion
(contd)
Risk reduction
Coronary heart disease risk factors
Modifiable risk factors
Diabetes
Systolic and/or diastolic hypertension
Smoking
Obesity
Physical inactivity
Health Promotion
(contd)
Health Promotion
(contd)
Health Promotion
(contd)
Health Promotion
(contd)
Health Promotion
(contd)
Health Promotion
(contd)
Health Promotion
(contd)
Healthy Lifestyles
Health Promotion
(contd)
Healthy Lifestyles
(contd)
Health Promotion
(contd)
Healthy eating
Healthy fats
Foods high in monounsaturated fat
Foods high in polyunsaturated fat
Foods high in omega-3
Health Promotion
(contd)
Health Promotion
(contd)