Cardiac Clinical Features

Cardiac Clinical Features:

Chest Pain:
Most common presentation of cardiac disease. Often due to myocardial ischaemia and angina pectoris  described as tight, constricting and squeezing in substernal region – typically precipitated by exercise and relieved by rest (angina pectoris).
Prolonged, intense, dull pain  indicative of myocardial infarction.
If radiates to shoulder and/or arms  suggests cardiac lesion.
Not likely to be cardiac pain if shooting, short duration (<30 secs), continually varying location, in younger person

Differential Diagnosis of Chest Pain:
Pleuritic- sharp pain worse on cough, movement or deep breath
– pneumonia; pneumothorax; pulmonary embolus
Central chest pain- angina; MI; osteophagitis
Chest wall tenderness- rib fracture

Dyspnoea:
Shortness of breath – unpleasant sensation. Usually more acute onset if cardiac rather than pulmonary.
Orthopnoea – dyspnoea when lying supine.

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Bradycardia:
Heart rate less than 60 beats/minute (may be normal in athletes)
May be due to drugs, infection, myocardial infarction, sick sinus syndrome, hypothyroidism

Palpitations:
Sensation of forceful, pounding, irregular, rapid heartbeat

Oedema:
If cardiac induced  dependent bilateral ankle swelling worse at and of day

Syncope:
Transient loss of consciousness. If cardiac induced – due to lack of cerebral blood supply

Blood Pressure:

Pulse Rate and Rhythm:
Normally taken at wrist

Heart sounds:
(see Pocket Podiatrics if no other refs)

Area’s for sounds:
• aortic area
• pulmonary area
• tricuspid area
• Erb’s point
• Mitral area (cardiac apex)

Use of stethoscope:
• first and second sounds are more clear than third and fourth

Normal sounds:
First heart sound (S1):
• from closure of the tricuspid and mitral valves
• heard at mitral and tricuspid areas with diaphragm of stethoscope
• louder in mitral stenosis; softer in mitral regurgitation

Second heart sound (S2):
• from closure of the aortic and pulmonary valves
• heard at aortic and pulmonary areas with diaphragm of stethoscope

Third heart sound (S3):
• from rapid filling of ventricles
• heard at mitral area with bell of stethoscope

Fourth heart sound (S4):
• from ejection from atrium into a distended ventricle
• heard at mitral area with bell of stethoscope; just before S1

Ejection systolic click:
• can be heard early in systole with a bicuspid aortic valve and systemic hypertension

Murmurs:
• Distinguishable from heart sounds due to longer duration
• due to turbulent blood flow
• not necessarily due to pathology