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Clinical Methods in Cardiology
RS Sharma
CHAPTER 1:
History Taking
SUBCLINICAL DISEASE; ASYMPTOMATIC PATIENTS
Presenting Complaint
Functional Impairment
Past History
Drug History
Family History
Social History
Occupational History
DYSPNEA
Mechanism of Dyspnea
Dyspnea in Heart Disease
Dyspnea Resulting from Chemical Stimuli
Attacks of Dyspnea
Dyspnea Associated With High-Altitude
Pulmonary Edema
How to Diagnose with Aid of Dyspnea?
Dyspnea in Normal Subjects
Dyspnea at Rest
Arrhythmias
CHEST PAIN
Pain of Myocardial Infarction
Pain in Acute Thoracic Disease
Pain Associated with Anxiety States
Pain Associated with Herpes Zoster
Musculoskeletal Pain
Abdominal Pain
PALPITATIONS
Associated Symptoms
Examination and Recording of an ECG During an Attack
DIZZINESS AND SYNCOPE
Fainting Attacks in Tetralogy of Fallot
Carotid Sinus Syncope
Cough Syncope
OTHER SYMPTOMS OF HEART DISEASE
Cough and Hemoptysis
Fatigue
Nocturia and Polyuria
Squatting
Hoarseness
Edema
Cyanosis
Loss of Weight (Cardiac Cachexia)
FUNCTIONAL AND THERAPEUTIC CLASSIFICATION OF HEART DISEASE
Functional Capacity (Four Classes)
Therapeutic Classification (Five Classes)
CHAPTER 2:
Physical Examination
APPROACH TO THE PHYSICAL EXAMINATION
The Radial Pulse
Other Pulses
Measurement Technique in the Arms (Figs 2.3, 2.5 and 2.6)
Artifacts in Measurement
Blood Pressure in the Legs
Pulses Alternans and Pulsus Paradoxus
EXAMINATION OF ORGANS AND REGIONS OTHER THAN THE HEART
Eyes (Figs 2.7A and B, Fig. 2.8, Figs 2.16 to 2.20, 2.24 and 2.27)
Mouth (Figs 2.7C and D)
Ears (Fig. 2.25)
Neck
Venous Pulse and Venous Pressure (Figs 2.21 to 2.23)
Normal Venous Pulse
Abnormal or Exaggerated Waves
Arms
Fingers (Figs 2.9 to 2.15)
Lungs
Abdomen (Figs 2.34 to 2.36)
Lower Extremities (Fig. 2.26 and 2.28)
INSPECTION (FIG. 2.29)
Visible Pulsations
Periodic Breathing
Palpation
Apex Beat (Figs 2.30, 2.32 and 2.33)
Thrills
Palpable Impulses
Palpable Gallops
Percussion
Auscultation (Figs 2.37 and 2.46)
Technique
Heart Sounds (Figs 2.45A to D)
Heart Murmurs (Figs 2.45A to D)
Pericardial Friction Rubs
INTEGRATION OF CARDIAC PHYSICAL FINDINGS
Some Objective Gradings in Cardiology Palpation and Auscultation
Apex Impulse
Force
Systemic Manifestations
Clinical Findings in Case of Acute Myocardial Infarction
Clinical Findings of Angina
Differential Diagnosis
Clinical Features of Hypertension
Malignant Hypertension
Complications
Dissection of the Aorta
RENAL ARTERY STENOSIS
CARDIAC FAILURE
Definition
Factors Precipitating Failure
Summary
CLINICAL FINDINGS
Left Ventricular Failure
Symptoms
Signs
Right Ventricular Failure
Symptoms
Signs
High Output Failure
Symptoms
Signs
Acute Heart Failure
Differential Diagnosis
Noncardiac and Nonthoracic Conditions Simulating Cardiac Failure
Lung Disease and Acute Respiratory Tract infections Presenting with Respiratory Symptoms
Massive Pulmonary Embolism
Diseases of the Pericardium and Myocardium
CHAPTER 3:
Congenital Heart Disease
INTRODUCTION
SURGICALLY MODIFIED DISEASE
CLASSIFICATION OF CONGENITAL HEART DISEASE
ATRIAL SEPTAL DEFECT
Cardinal Features and Pathogenesis
Clinical Findings
Symptoms and Signs
Differential Diagnosis
Complications
PULMONARY STENOSIS
Cardinal Features
Clinical Findings
Symptoms and Signs
Differential Diagnosis
Cardinal Features and Pathogenesis
Clinical Findings
Symptoms and Signs
Hemodynamic Findings
Other Physical and Cardiac Signs
VENTRICULAR SEPTAL DEFECT
Differential Diagnosis
Complications
PATENT DUCTUS ARTERIOSUS
Cardinal Features
Clinical Features
Symptoms and Signs
Differential Diagnosis
EISENMENGER'S SYNDROME
Cardinal Features and Pathogenesis
Acquired Pulmonary Hypertension (Eisenmenger Reaction)
Use of the Term Eisenmenger's Syndrome
Clinical Findings
Symptoms and Signs
Differential Diagnosis
COARCTATION OF THE AORTA
Cardinal Features and Pathogenesis
Clinical Findings
Symptoms and Signs
Cardiac Signs
CLINICAL FINDINGS
Symptoms and Signs
DIFFERENTIAL DIAGNOSIS
Tricuspid Atresia
Total Anomalous Pulmonary Venous Drainage
Other Lesions
CHAPTER 4:
Valvular Heart Disease
CLASSIFICATION OF VALVULAR DISEASE
MITRAL VALVE DISEASE
Classification of Mitral Valve Disease
Cause of Mitral Valve Disease
MITRAL STENOSIS
Onset of Atrial Fibrillation
Clinical Findings
Symptoms
Signs
Differential Diagnosis
MIXED MITRAL STENOSIS AND INCOMPETENCE
Clinical Findings
Symptoms
Signs
Differential Diagnosis
MITRAL INCOMPETENCE
Clinical Findings of Mitral Valve Prolapse (MVP)
Differential Diagnosis Mitral Valve Prolapse
Clinical Findings of Mitral Incompetence
Symptoms
Signs
Differential Diagnosis of Mitral Incompetence
AORTIC VALVE DISEASE
Classification
Acute and Chronic Aortic Incompetence
Causes of Aortic Valve Lesions
Hemodynamically Insignificant Lesions
Clinical Features
Predominant Aortic Stenosis
Importance of Aortic Stenosis
Cause of Aortic Stenosis
Clinical Findings
Diagnosis
Differential Diagnosis
Predominant Aortic Incompetence
Acute Lesions
Chronic Lesions
Clinical Findings
Differential Diagnosis
MULTIPLE VALVE INVOLVEMENT
Combined Mitral and Aortic Valve Disease
Clinical Course of Combined Lesions
Combined Mitral and Tricuspid Valve Disease
MODIFIED VALVULAR HEART DISEASE SECONDARY TO SURGERY/BALLOON MITRAL VALVOTOMY
Mitral Valvotomy
Clinical Findings
Symptoms
Signs
Electrocardiographic Findings
X-Ray Findings
PATIENTS WITH ARTIFICIAL VALVES
Clinical Findings
Symptoms
Signs
Differential Diagnosis
Complications
CHAPTER 5:
Infective Endocarditis
CHANGING CHARACTERISTICS OF ENDOCARDITIS
Changing Etiology and Symptoms
Special Valve and Congenital Factors
Precipitating Factors
Other Factors and Influences
Subacute Infective Endocarditis
Acute Infective Endocarditis
Diagnosis
Differential Diagnosis
Prosthetic Valve Endocarditis
CHAPTER 6:
Myocardial Disease
INTRODUCTION
Myocarditis and Cardiomyopathy
General Considerations
RHEUMATIC FEVER
Etiology
Diagnosis
Clinical Findings
Symptoms
Signs
Differential Diagnosis
Complications
CHRONIC CARDIOMYOPATHIES CONGESTIVE IDIOPATHIC OR PRIMARY CARDIOMYOPATHY
Clinical Findings
Symptoms
Signs
Differential Diagnosis
HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Classification and Diagnosis
Criteria for Diagnosis
Clinical Findings
Symptoms
Signs
Differential Diagnosis
Complications
RESTRICTIVE CARDIOMYOPATHY
CHAPTER 7:
Pericarditis
DIFFERENTIAL DIAGNOSIS
COMPLICATIONS
CARDIAC TAMPONADE
Clinical Findings
Symptoms
Signs
Differential Diagnosis
Complications
PERICARDIAL CONSTRICTION
Clinical Findings
Symptoms
Signs
Differential Diagnosis
Complications
CHAPTER 8:
Pulmonary Heart Diseases
INTRODUCTION
Pulmonary Hypertension
Primary Pulmonary Hypertension
Right Heart Failure Secondary to Lung Disease
Massive Pulmonary Embolism: Acute Right Heart Failure (Acute Cor Pulmonale)
Clinical Findings
Symptoms
Signs
Differential Diagnosis
RIGHT HEART FAILURE SECONDARY TO CHRONIC LUNG DISEASE
Clinical Findings
Symptoms
Signs
Differential Diagnosis
Complications
DIFFERENTIATION OF HEART DISEASE AND LUNG DISEASE
Clinical Findings
Symptoms
Signs
CHAPTER 9:
Some other Clinically Important Cardiovascular Conditions
CARDIAC TUMORS
Clinical Findings
Differential Diagnosis
Hypotension
Causes of Hypotension
Clinical Features
Hypotension Associated with Inadequate Blood Volume
Neurocirculatory Asthenia (Cardiac Neurosis)
Clinical Findings
Differential Diagnosis
ABNORMAL POSITION OF THE HEART
Cause of Abnormal Position of the Heart: Associated Conditions
Dextrocardia and Dextroversion
Displacement Due to Lung Disease
Displacement Due to Abnormalities of the Thoracic Cage
HEART DISEASE IN PREGNANCY
Introduction
Classification
Physiologic Changes in the Mother as a Result of Pregnancy
Physiologic Changes with Labor and the Puerperium
Cardiac Complications of Pregnancy
Difficulty in Diagnosis of Heart Disease in Pregnancy
Hypertension in Pregnancy
Hypertensive Disorders of Pregnancy
Essential Hypertension
Pre-eclampsia Eclampsia
Etiology
Clinical Findings
Clinical Course
CHAPTER 10:
Thyrotoxic Heart Disease and Some other Heart Diseases of Clinical Importance
INTRODUCTION
Differential Diagnosis
MYXEDEMA AND MYXEDEMA HEART
Clinical Findings
Symptoms
Differential Diagnosis
Alcoholic Cardiomyopathy
Involvement of the Liver
Relationship of Beriberi Heart Disease to Alcoholic Cardiomyopathy
Clinical Findings
Differential Diagnosis
CHAPTER 11:
Cardiac Arrhythmias
INTRODUCTION
Clinical Features of Tachyarrhythmias in General
Symptoms
Features of Special Importance
Diagnosis
Diagnostic Features of Paroxysmal Atrial Tachycardia
Differential Diagnosis
Clinical Differentiation
ATRIAL FIBRILLATION AND ATRIAL FLUTTER
Clinical Course
Atrial Fibrillation in Mitral Stenosis
Chronic Atrial Fibrillation
Pulse Deficit
Clinical Findings
Clinical Findings in Ventricular Tachycardia
CHAPTER 12:
Frequently Asked Questions (FAQs) in Bedside Clinical Examination and Viva Voce
HISTORY TAKING
PHYSICAL EXAMINATION
Pulse
INDEX
TOC
Index
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