signs n symptoms n clinical examination

SEM 3 PCL 1

(note: all highlighted portions have specific relevance to atrial fibrillation)

Atrial fibrillation: Signs and symptoms and clinical examination
Starting with taking a history…
1) Introduction
2) CC
3) HPI: WWQQAAB , functional disability
4) System review
5) Past medical and surgical Hx
-especially diabetes, hypertension, dyslipidaemia
6) Medication and drug Hx
7) Allergies
8) Family Hx
- Positive hX of early atherosclerotic Dz
9) Social Hx
-occupation
-smoking
-alcohol
-lifestyle (sedentary, unhealthy diet)
-living conditions, marital status
10) Mental status/ Obstetric Hx (only if relevant)

System specific Qs regarding:
1) Angina
2) -Exertional dyspnoea
-Paroxysmal nocturnal dyspnoea
-Orthopnoea
3) Peripheral oedema
4) Palpitations!!
5) Intermittent claudication
6) Syncope
7) Fatigue (and light headedness/dizziness)


physical examination of the CVS

General appearance à hands à pulses + BP à face à neck à praecodium >> inspection >> palpation >> percussion >> ausculatation à auscultation of the neck à back à abdomen à lowerlimbs





1) General appearance
- Labored respiration ( dyspnoea)
- Cardiac cachexia

2) Hands
-clubbing (note if there is loss of angle btwn nail bed and finger)
-splinter haemorrhages
-oslers nodes (red nodules on finger pulp)
-xanthomata (yellow/orange lipid deposits)

3) Arterial pulse
a) Rate
-Tachycardia
to compensate for poor CO, increase of HR
-bradycardia

b) Rhythm
-irregularly regular/chaotic

Chaotic cardiac impulses(some contracting, some relaxing) > Loss of coordinated contraction of atrium > AV node bombarded with impulses, but unable to conduct all > so ventricles do not beat VERY rapidly (150-180bpm, usual 55-90) but IRREGULARLY

-regularly irregular

c) Radiofemoral delay

d) Character and volume

Variable amplitude, due to differing diastolic filling times



Blood pressure

-Hypotension, due to insufficient time for diastolic filling
-hypertension






4) Face
-jaundice
-xanthelesmata (cholesterol deposits)
-mitral facies
-high arched palate

5) Neck
-carotid arteries
(amplitude, shape, volume)

-jugular venous pressure-pulsation

Character
No ‘a’ wave
‘a’ wave due to atrial contraction but in fibrillation, no coordinated contraction


Amplitude
6) Praecordium
Inspection
-scars
-skeletal abnormalities
-pacemaker/defibrillator

Palpation
-apex beat
-parasternal impulse
-thrills

Percussion

Auscultation
-4 areas
-1st heart sound
-2nd heart sound
-heart murmurs (timing is important)
-dynamic manoeuvres

7) Auscultation of the neck
-bruits

8) Back
-checking the lungs
-pitting oedema of sacrum

9) Abdomen
- Liver: enlarged/pulsatile
- Ascites
- Splenomegaly

10) Lower limbs
(similar to hand=clubbing,xanthomata)





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