EXAMINATION OF THE HEART Doc. MUDr. Lubomír Křivan, Ph.D. Interní kardiologická klinika FN Brno History  Heart disease in patient´s history  Family history  Risk factors ( gender, age, smoking, cholesterol, diabetes)  Physical performance  Syncope  Arrhythmias  medication General inspection of the patient  Cyanosis  Swelling  Dyspnea (orthopnoic position)  Clubbing  Facies mitralis  Increased jugular filling  Xanthelasma (yellow plaques close to eyelids) General inspection of the patient  Cyanosis Reduced hemoglobin in capillary blood > 50g/l General inspection of the patient  Dyspnea (orthopnoic position)  Left ventricular failure with increased blood presuure in lung circulation  Vertical position decrease the venous blood return General inspection of the patient  Clubbing  Congenital heart disease with cyanotic R –L shunt General inspection of the patient  Facies mitralis  Mitral stenosis  Pale colour around mouth, eyes and forehead contrast with violet on nose and lips General inspection of the patient  Xanthelasma (yellow plaques close to eyelids) General inspection of the patient  Splinter hematomas Typical for infectious endocarditis Inspection of the heart  Asymetrical bulge of the thorax – too big heart – voussure  Pulsation – enlarged left or right ventricle Palpation of the heart  Apex of left ventricle – point of maximum impulse Auscultation of the heart Heart valves Heart sounds Gallop Incerased BP in LA during left ventricular failure + tachycradia Fast opening of the AV valves and rapid filling of the ventricles Murmurs  SYSTOLIC  - ejection (Ao stenosis)  - regurgitation (Mi insufficiency)  DIASTOLIC  - flow related (Mi stenosis)  - regurgitation (Ao insufficiency) Mitral stenosis Mitral stenosis Mi stenosis Mitral regurgitation Aortic stenosis Aortic stenosis Ao stenosis Aortic regurgitation Continuous systolic murmur Extracardiac murmurs  Pericardial friction rub - pericarditis  Functional murmur – anemia, hyperkinetic circulation Blood pressure ECG (Willem Einthoven 1893) ECG history ECG – limb leads ECG- precordial leads ECG X – ray (W.C. Roentgen 1895) Tumor of the left lung PNO Diaphragmatic hernia – stomach in the chest Cardiac tamponade After pericardial punction CT , MRI Coronary arteries CAD - AIM Noninvasive treadmill tests RCA angiography LCA angiography Invasive assessment of arrhythmias  Electrophysiology – capacity of the conduction systém, induction and precise classiffication of arrhythmias – followed by RFA EP Lab ICEG Catether placement during AVNRT ablation PK CSHS PS RF Chest pain Closed RIA PCI wire in the artery After treatment with PTCA Pulmonary oedema Pulmonary oedema RLVG Right ventricular failure Thank you