1. Principles of Clinical History and Examination
    2. 1. Managing clinical encounters with patients
    2. General aspects of history taking
    3. General aspects of examination
  2. System-based Examination
    3. 4. The cardiovascular system
    5. The respiratory system
    6. The gastrointestinal system
    7. The nervous system
    8. The visual system
    9. The ear, nose and throat
    10. The endocarine system
    11. The reproductive system
    12. The renal system
    13. The musculoskeletal system
    14. The skin, hair and nails
  3. Applying History and Examination skills in Specific Situations
    4. 15. Babies and children
    16. The patient with mental disorder
    17. The frail elederly patient
    18. The deteriorating patient
    19. The dying patient
  4. Putting History and Examination Skills to use
    5. 20. Preparing for assessment
    21. Preparing for practice
System-based Examination
4. The cardiovascular system
HEART
Anatomy and physiology
The history
Common presenting symptoms
▢ Chest pain:
❖ Intermittent chest pain:
❖ Acute chest pain:
▢ Dyspnoea (breathlessness):
▢ Palpitation:
▢ Syncope and presyncope:
▢ Oedema:
▢ Other symptoms of cardiac disease:
Past medical history
Drug history
Family history
Social history
The physical examination
General examination
▢ Hands:
▢ Face:
Arterial pulses
▢ Rate and rhythm:
▢ Volume and character:
Blood pressure
▢ Hypertension:
▢ Korotkoff sounds:
▢ Common problems in BP measurement:
Jugular venous pressure and waveform
Precordium
▢ Inspection:
▢ Palpation:
▢ Auscultation:
❖ Heart sounds:
◉ First heart sound:
◉ Second heart sound:
◉ Third heart sound:
◉ Fourth heart sound:
◉ Added sounds:
❖ Murmurs:
◉ Systolic murmur:
◉ Diastolic murmur:
◉ Continuous murmurs:
Interpretation of the findings
Investigations
▢ Haematology and Clinical chemistry:
▢ Electrocardiography:
❖ Ambulatory ECG monitoring:
❖ Exercise ECG:
▢ Ambulatory blood pressure monitoring:
▢ Chest X-ray:
▢ Echocardiography:
▢ Radionuclide studies:
▢ Cardiac catheterisation:
▢ Computed tomography and magnetic resonance imaging:
PERIPHERAL ARTERIAL SYSTEM
Anatomy and physiology
The history
Common presenting symptoms
▢ Leg pain:
❖ Asymptomatic ischaemia:
❖ Intermittent claudication:
❖ Night pain:
    ❖ Rest pain:
      ❖ Tissue loss (ulceration and/or gangrene):
        ❖ Acute limb ischaemia:
          ❖ Compartment syndrome:
            ▢ Abdominal pain:
            ❖ Mesenteric ischaemia:
              ❖ Abdominal aortic aneurysm:
                ▢ Digital ischaemia:
                ❖ Blue toes:
                  ❖ Vasospastic symptoms:
                    ▢ Stroke:
                      Past medical history
                      Drug history
                      Family history
                      Social history
                      The physical examination
                      ▢ Buerger's test:
                      ▢ Ankle:brachial pressure index:
                      Investigations
                      PERIPHERAL VENOUS SYSTEM
                      Anatomy and physiology
                      The history
                      Common presenting symptoms
                      ▢ Pain:
                        ▢ Limb swelling:
                          ▢ Skin changes:
                          ❖ Chronic venous ulceration:
                          ▢ Superficial venous thrombophlebitis:
                          Past history
                          The physical examination
                          Investigations