CARDIO VASCULAR SYSTEM

Name Age Sex Occupation Address

Chief complanints

H/O Presenting compliants

Chest Pain Breathlessness

Duration Duration
Site Onset
Onset Progression
Nature Grade
Bought on by(Exertional work) Postural and Diurnal Variation
Continuos/Intermittent Aggravating/relieving factor
Radiation PND/Orthopnea
Postural Variation
Aggravating/reliving factor
Associated with Nausea, Vomiting, Sweating
Associated with food intake

Palpitation Loss of consciousness

Duration Episodes /day
Regular/Irregular Duration
Paroxysmal/Not Total/Partial loss of consciousness
Brought on by Recovery time
Aggravating and relieving factor Associated with fits, bladder/bowel disturbances
Associated with pain and syncope Time of the last episode

Cough with expectoration Bloody Cough

Duration No of episodes and duration
Mode of onset Colour
Quantity Followed by malena
Colour /Odour Assocaited with food particles
Postural /diurnal variation
Aggravating/ relieving factor

Negative History

Symptoms of RHF
H/O Pedal Edema
H/O abdominal distention
H/O dyspepsia
H/O Rt Hypochondrial pain
H/O puffiness of face

Symptoms of LHF
H/O dyspnea
H/O bloody sputum
 H/O PND/orthopnea
H/O palpitation
H/O easy fatigue ability
H/O palpitation
H/O syncope
H/O voice change
H/O dysphagia
H/O oliguria

Symptoms of RF
H/O fever with pain and sore throat
H/O involuntary movements
H/O skin manifestations like rashes, nodule

Symptoms of Congenital Heart Disease

H/O cyanotic episodes

Symptoms of Pulmonary Hyertension

H/O Recurrent respiratory infection

Past History

H/O previous similar episodes

H/O rheumatic fever
H/O HT, DM, TB , Ischemic Heart Disease
H/O STD
H/O chronic respiratory tract infection, cyanotic spell
H/O any surgery
H/O chronic fever(Subacute bacterial endocarditis)

Family History

Any other family members with similar compliants

Personal History
Smoking
Alcohol
Diet
Menstrual history

Treatment History
 Examination
General Examination
Consciousness
Comfortable
Afebrile
Built
Pallor
Jaundice
Clubbing
Cyanosis
Pedal Edema
Significant lymphadenopathy
Markers of Congenital Heart disease
Hypertelorism
Low set ears
High arched palate
Syndactyly
Polydactyly
Arachnodactyly
Kyphosis
Webbed neck
Markers of Infective Endocarditis
Anemia
Jaundice
Fever
Hand (Clubbing, Oslers node, Splinter Hemorrhage)
Spleenomegaly
Markers of Rheumatic Heart Disease
Erythema nodosum
Subcutaneous nodules
Markers of TB
Phlyctern
Scar/Sinus in the neck
Tenia versicolor
Lupus vulgaris
Erythema nodosum
Gynacomastia –INH
Markers of HIV
Oral hairy leukoplakia
Oral candidiasis
Molluscum contagiosum
Herpetic infection(Zooster)
Generalized lymphadenopathy
Vital Signs
Pulse (Rate, Rhythm, Volume, Character, Felt in all palpable peripheral vessels, any
Radio femoral delay)
 BP(All limbs)
Temperature
JVP
Peripheral signs of Aortic Regurgitation
Hills Sgin
Light house sign
Locomotor brachii
Collapsing or Water hammer pulse
Pulses bisferiens
Landlofi’s sign(Pupillary size according to cardiac cycle not by light)
Becker’s sign(Rentinal artery pulsation)
de Musset’s sign(Head bobbing with each heart beat)
Muller’s sign(Systolic pulsation in Uvula )
Quinke’s sign(Capillary pulsation over the lips and nail bed while pressing with glass
slide)
Dancing Carotid ( Corrigan’s sign)
Duroziez’s sign(Auscultation by ‘bell’ over femoral artery while compression:
Proximal - Systolic murmer, Distal – Diastolic murmur)
Duroziez’z murmur (Auscultation by ‘diaphragm’ over femoral artery while
compression: Distal – Diastolic murmur)
Traube’s sign(Pistol shot femorals)
Rosenbach’s sign(liver pulsation)
Gerhardt’s sign(enlarged spleen pulsation)

Examination of CVS

Inspection
Chest wall symmetry, shape,kyphoscoliosis
Apical impulse
Tracheal position
Pulsations
Epigastric – RVH
Parasternal – RVH,LAE
Supra & Infraclavicular, suprasternal and neck – Aortic aneurysm
Interscapular, Suprascapular – Coarctation of Aorta
Precordial bulge
Sinus
Scar
Dilated veins
Discharge
Dropping of shoulder
Oral cavity

Palpation
Apical impulse
Site
Type(Heaving – AS, Hyperdynamic – AR, Tapping – MS )
 Association with thrill
Epigastric pulsation
Parasternal Heave
Grade I - Visible
Grade II - Visible +Palpable but obliterated
Grade III - Visible +Palpable not obliterated
Trill over precordium and carotids
Palpable sounds
Tracheal position

Percussion
Herat borders are with in the normal limit

Auscultation
Mitral – First and second heart sounds heard
MDM –A rough rumbling low pitched MDM of grade__heard with the bell of the
stethoscope heard when the patient is in left lateral position with breath held in
expiratory apnea
PSM – A high pitched soft blowing PSM of grade__heard with the diaphragm of the
stethoscope, which is conducted to axilla and back, when the patient is in the left lateral
position with breath held in expiratory apnea
Aortic – First and Second heart sounds heard
ESM – A crescendo decrescendo ESM of grade__ heard with the diaphragm of the
stethoscope and conducted to carotids when the patient leaning forward with the breath
held in the expiratory apnea
EDM – A high pitched decrescendo EDM of grade__ heard with the diaphragm of the
stethoscope when the patient leaning forward with the breath held in the expiratory
apnea
Pulmonary – First and Second heart sounds heard
Tricuspid – First and Second heart sounds heard

Other systems
RS NVBS, Basal crepitations
CNS Normal
Abdomen No organomegaly
No free fluid

Dianosis
A case of acquired/congenital heart disease of __(rheumatic) etiology with MS/MR/AS/AR. The
patient is___(Sinus rhythm)__(failure/Not)__with(IE or not).