Cardiac Clinical Features:
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 personDifferential 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 fractureDyspnoea: Shortness of breath – unpleasant sensation. Usually more acute onset if cardiac rather than pulmonary. Orthopnoea – dyspnoea when lying supine.Bradycardia: Heart rate less than 60 beats/minute (may be normal in athletes) May be due to drugs, infection, myocardial infarction, sick sinus syndrome, hypothyroidismPalpitations: Sensation of forceful, pounding, irregular, rapid heartbeatOedema: If cardiac induced dependent bilateral ankle swelling worse at and of daySyncope: Transient loss of consciousness. If cardiac induced – due to lack of cerebral blood supplyBlood Pressure:Pulse Rate and Rhythm: Normally taken at wristHeart 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 fourthNormal 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 regurgitationSecond heart sound (S2): • from closure of the aortic and pulmonary valves • heard at aortic and pulmonary areas with diaphragm of stethoscopeThird heart sound (S3): • from rapid filling of ventricles • heard at mitral area with bell of stethoscopeFourth heart sound (S4): • from ejection from atrium into a distended ventricle • heard at mitral area with bell of stethoscope; just before S1Ejection systolic click: • can be heard early in systole with a bicuspid aortic valve and systemic hypertensionMurmurs: • Distinguishable from heart sounds due to longer duration • due to turbulent blood flow • not necessarily due to pathology