Name/age/sex/occupation/address

Presenting complaints:
History of presenting complaints:

Chest Pain:

Duration
Site
Mode of onset
Nature
Severity and duration of episode
Radiation
Continuous/intermittent
Brought on by
Aggravating/ Relivingfactors
Associated features -sweating, palpitation
Associated with food intake

Dyspnea:

Duration
Mode of onset
Progression
Grade
Aggravating / reliving factors
H/o PND, orthopnea
Associated symptoms- wheeze, cough with expectoration, chest pain

Palpitation:
Duration

Regular/ Irregular
Paroxysmal/ not
Brought on by
Aggravating/ Reliving factors
Associated chest pain, syncope

Loss of consciousness:

Episodes/day
Duration
Total/ partial loss of consciousness
Recovery time
Associated fits, bladder/bowel disturbances
Time of last episode
Cough with expectoration:

Duration
Mode of onset
Quantity
Colour/ odour
Postural / Reliving factors
Blood on coughing
o No of episodes
O Colour

o Followed by malena
o Associated with food particles

Negative History:
.Symptoms of RHF
o H/o pedal edema
o H/o abdominal distension
o H/o dyspepsia
o H/o right hypochondrial pain
o H/o puffiness of face
Symptoms of RF
o H/o fever with pain, sore throat
o H/o involuntary movements
o H/o skin manifestations like rash, nodules
Symptoms of Left sided disease
o H/o voice change, dysphagia
o H/o oliguria
Symptoms of congenital disease
o H/o cyanotic episodes
o H/o squatting
Symptoms of PHT
o Recurrent respiratory infection
o Syncope

oHemoptysis(pulmonary apoplexy)
o Chest pain

Past History:

H / o previous similar episodes

H/o Rheumatic fever elaboratefany epistaxis)
H/o HT, DM, TB, IHD, STD, Surgery
H/o chronic respiratory tract infection, cyanotic spells
H/o chronic fever (subacute bacterial endocarditis)
Family History:
Elaborate
H/o HT, DM
H / o abortions in female

Personal History:

.Smoking
Alcohol
Diet
Sexual History
.Menstrual History
Treatment History:

Summary:
Age/sex/name? Personal History? Family history? PC

Other relevant positivefeatures

Probable system? CVS

The disease is probably. (cong/acq). Probably a . ecurrent) heart disease

involving the. t/rt/both) side(s), the probable valve(s) involved a r e . . The
patient shows the signs/symptoms of. *****e
.. VE/RVF/CCF)

Examination of CVS case

General examination:

Conscious

Comfortable
Oriented
Build
Nourishment
Febrile/ afebrile
Jaundiced/not
Pallor

Clubbing -grade
Cyanosis
Pedal edema with refilling time
o Rapid- renal <45 secs
o Slow-CCF

Significant lymphadenopathy
Markers of Congenital HD

Hypertension
 Low set ears

Polydactyly
.Syndactyly
Arachnodactyly
Amelia, hyomelia
Kyphoscoliosis
Webbed neck

Markers of E

Anemia, jaundice, fever

Osler's nodules, clubbing,splinter haemorrhages Hand
J a n e way lesions
Spleenomegaly
Roth's spots(Ophthalmoscopy)

Markers of Rheumatic HD

Markers of Ischemic HD

Markers of syphilis

.Alopecia
AR pupil
Retinitis

Gummatous lesions- Tibia, palate, tongue, sternum

Septal perforation
Testicular sensation loss

Markers of HIV, TB

Vital signs:

Pulse:

Rate

Rhythm
Volume
Character
F e l t in all peripheral vessels
Any RF / any PD
Condition of vessel wall

BP

Respiratory rate

Rate
 .Rhythm
Type

Temperature
JVP

Peripheral signs of AR- signs of wide pulse pressure:

Lighthouse sign - Alternate flushing and blanching of forehead

Landolff's sign pupil size varies with each heart beat

B e c k e r ' s sign - Retinal artery pulsations

Muller's sign Systolic pulsations of uvula

De Musset's sign - Head bobbing with each heartbeat

Corrigan's sign - Dancing carotids

Quincke's sign -Capillary pulsation of nail bed

Collapsing pulse
Pulsus bisferans -severe AR
Rosenbach's sign - Pulsation of liver

Gerhardt's sign - Pulsation of spleen

Traube's sign Pistol shot femoral

Hil's sign -

Popliteal systolic BP> Brachial BP >20 mm

o Mile-20-40
o Moderate 40-60
o Severe ->60

Duroziez's murmur Double murmur in femoral artery

Local Examination of CVS:

Inspection:
Chest wall symmetry and shape
Kyphoscoliosis
Apical impulse
Tracheal position
Pulsations
o Epigastric, hypochondrial
o Parasternal
o Supra & infraclavicular
o Suprasternal, neck
o Interscapular, suprascapular
Precordial bulge
Dilated veins
Signs of surgeries, scars
Drooping of shoulders
Oral cavity
Palpation:
Apical impulse site/type/ associated thrill or sound
Epigastric pulsations
Parasternal heave
Thrills over precordium/carotids
Palpable sounds (P2)

Tracheal position
Percussion:

Right border corresponds to right border of sternum

Left border corresponds to apical impulse
Liver dullness is felt in .. *****

Auscultation

Mitral
o First and second heart sounds are heard
o S1/$2-loud/normal/soft
oAny $3 or S4

o MDM:A rough rumbling low pitched MDM(of grade) heard with the bell of the
stethoscope with opening snap and PSA (pre systolic attenuation) and the patient
put left lateral position with breath held in expiratory apnea
o PSM: A high pitched, soft blowing PSM (of grade) heard with the diaphragm of the
stethoscope, conducted to the axilla and back, the patient put in left lateral with
breath held in expiratory apnea
Aortic:
o First and second heart sounds are heard
o $1/$2 loud/normal/soft
o Any ejection click
o ESM: A crescendo decrescendo ESM(of grade) heard with the diaphragm of the
stethoscope and conducted to the carotids, the patient leaning forward and breath
held in expiratory apnea
o EDM:A decrescendo pitched EDM( of grade) is heard with diaphragm of the
stethoscope (better heard in the ll aortic area say as LT with ICS parasternal) with
the patient leaning forward with breath held in expiratory apnea
Pulmonary:
o First and second heart sounds are heard
o $1/$2-Ioud/normal/soft
o $2? Split? Narrow/ normal/ wide fixed/ reverse
O Any ejection click
o For murmurs
S e e the aortic area
Say as in inspiratory apnea
N o conduction as in ESM of AS
 Patient in lying posture

Tricuspid:
o First and second heart sound heard

oS1/$2-oud/
o Any S3/ S4
normal/ soft
Refer mitral area
S a y as in inspiratory apnea
MDM: Patient leaning forward
PSM: Patient leaning forward, conduction to right sternum

Other systems:

Respiratory system:
o NVBS
o Basal crepitations
Abdomen:
o Any added sounds
o No organomegaly
o No free fluid
CNS:
o No focal neurological deficit

Diagnosis:
Acquired/congenital heart disease of. .rheumatic) etiology with MS/MR/AS/AR.
The patient is . .notjin sound rhythm,. * *********** in failure. with /without
infective endocarditis complications.