The Art and Science of Cardiac Physical Examination : With Heart Sounds And Pulse Wave Forms

Preface vii Acknowledgment x Companion CD xv Color Plates xvii Approach to the Physical Examination of the Cardiac Patient 1(14) Reasons for Which Cardiac Assessment Is Sought 2(1) Cardiac Symptoms and Their Appraisal 2(2) Generation of Working List of Possible Diagnoses 4(2) Focused Physical Examination: Clinical Exercise 6(8) Focused Physical Examination: Practical Points 14(1) Arterial Pulse 15(34) Physiology of the Arterial Pulse 15(19) Assessment of the Arterial Pulse 34(10) Practical Points in the Clinical Assessment of the Arterial Pulse 44(2) References 46(3) Blood Pressure and Its Measurement 49(18) Physiology of Blood Flow and Blood Pressure 49(1) Physiology of Blood Pressure Measurement 50(2) Points to Remember When Measuring Blood Pressure 52(1) Factors That Affect Blood Pressure Readings 53(1) Interpretation of Blood Pressure Measurements 54(2) Use of Blood Pressure Measurement in Special Clinical Situations 56(8) References 64(3) Jugular Venous Pulse 67(46) Normal Right Atrial Pressure Pulse Contours 68(2) Jugular Venous Inflow Velocity Patterns and the Relationship to the Right Atrial Pressure Pulse 70(4) Jugular Venous Flow Events and Their Relationship to Jugular Venous Pulse Contours 74(7) Normal Jugular Venous Pulse Contour and Its Recognition at the Bedside 81(1) Individual Components of the Right Atrial Pressure Pulse, Their Determinants, and Their Recognition in the Jugulars 82(10) Abnormal Jugular Venous Pulse Contours as Related to Abnormal Jugular Venous Flow Velocity Patterns 92(4) Abnormal Jugular Contours 96(9) Assessment of Jugular Venous Pressure 105(2) Clinical Assessment of the Jugular Venous Pulse 107(3) References 110(3) Precordial Pulsations 113(28) Mechanics and Physiology of the Normal Apical Impulse 113(2) Physical Principles Governing the Formation of the Apical Impulse 115(3) Normal Apical Impulse and Its Determinants 118(2) Assessment of the Apical Impulse 120(13) Left Parasternal and Sternal Movements 133(1) Right Parasternal Movement 134(1) Pulsations Over the Clavicular Heads 134(1) Pulsations Over the Second and/or Third Left Intercostal Spaces 135(1) Subxiphoid Impulse 135(1) Practical Points in the Clinical Assessment of Precordial Pulsations 136(2) References 138(3) Heart Sounds 141(70) Principles of Sound Formation in the Heart 141(1) First Heart Sound (S1) 142(14) Clinical Assessment of S1 and Components 156(2) Second Heart Sound (S2) 158(1) Normal S2 159(3) Abnormal S2 162(12) Clinical Assessment of S2 174(5) Opening Snap (OS) 179(6) Third Heart Sound (S3) 185(13) Clinical Assessment of S3 198(2) Fourth Heart Sound (S4) 200(4) Clinical Assessment of S4 204(2) References 206(5) Heart Murmurs: Part I 211(64) Principles Governing Murmur Formation 211(3) Hemodynamic Factors and Cardiac Murmurs 214(1) Frequencies of Murmurs 214(2) Grading of Murmurs 216(1) Systolic Murmurs 216(1) Ejection Murmurs 217(15) Regurgitant Systolic Murmurs 232(1) Mitral Regurgitation 233(20) Tricuspid Regurgitation 253(5) Ventricular Septal Defect (VSD) 258(7) Clinical Assessment of Systolic Murmurs 265(4) References 269(6) Heart Murmurs: Part II 275(34) Diastolic Murmurs 275(1) Diastolic Murmurs of Mitral Origin 275(7) Diastolic Murmurs of Tricuspid Origin 282(1) Semilunar Valve Regurgitation 283(1) Aortic Regurgitation 283(7) Pulmonary Regurgitation 290(2) Clinical Assessment of Diastolic Murmurs 292(2) Continuous Murmurs 294(2) Persistent Ductus Arteriosus 296(2) Aorto-Pulmonary Window 298(1) Sinus of Valsalva Aneurysm 298(1) Coronary Arteriovenous Fistulae 299(1) Venous Hum 300(1) Mammary Souffle 300(1) Clinical Assessment of Continuous Murmurs 300(2) Pericardial Friction Rub 302(1) Innocent Murmurs 303(1) References 304(5) Elements of Auscultation 309(12) The Stethoscope 309(1) Auscultation Method 310(8) References 318(3) Pathophysiological Basis of Symptoms and Signs in Cardiac Disease 321(40) Pathophysiology of Mitral Regurgitation 321(4) Pathophysiology of Aortic Regurgitation 325(4) Pathophysiology of Mitral Stenosis 329(2) Pathophysiology of Aortic Stenosis 331(3) Pathophysiology of Myocardial Ischemia/Infarction 334(2) Pathophysiology of Hypertensive Heart Disease 336(2) Pathophysiology of Dilated Cardiomyopathy 338(2) Pathophysiology of Hypertrophic Obstructive Cardiomyopathy 340(2) Pathophysiology of Atrial Septal Defect 342(3) Pathophysiology of Diastolic Dysfunction 345(2) Pathophysiology of Constrictive Pericarditis 347(1) Pathophysiology of Cardiac Tamponade 348(3) Appendix 351(5) References 356(5) Local and Systemic Manifestations of Cardiovascular Disease 361(36) General Observations 361(3) Congenital Syndromes/Diseases 364(5) Vascular Diseases 369(3) Valvular Heart Disease 372(1) Endocrine and Metabolic Diseases 373(4) Inflammatory Diseases 377(1) Diseases of Connective Tissue and Joints 377(4) Pharmacological Agents 381(3) Musculoskeletal Diseases 384(2) Tumors 386(1) Synopsis 386(4) Acknowledgment 390(1) References 390(7) Index 397(16) About the Authors 413