Essentials of Bedside Cardiology

Because medical technologies for diagnosing cardiovascular disorders, such as echocardiography, can occasionally prove mistaken or misleading, many physicians know that it is best not to rely solely on their results. In this significantly enhanced second edition of his classic work, Essentials of Bedside Cardiology With a Complete Course in Heart Sounds and Murmurs on CD, Second Edition, Jules Constant, MD, offers an alternative to this problem by helping the physician to perfect the fine art of history-taking and physical examination. Moving beyond total reliance on laboratory data to the expert evaluation of personal patient data, Dr. Constant summarizes forty years of clinical experience with a proven battery of time-tested questions designed to elicit the crucial nuances of cardiac-related symptoms, and then provides a complete differential diagnosis for each demonstrated symptom. His method includes numerous practical tips for obtaining cardiac clues from physical appearance, measuring arterial and jugular pulses and pressures, and using a stethoscope. The core of the book is an extensive discussion of the art and science of diagramming and grading heart sounds and murmurs, ranging from S1 through S4 to ejection, systolic regurgitant, diastolic, and abdominal murmurs. An invaluable, stand-alone compact disc offering a seventy-minute course in auscultation, complete with heartsounds taken from actual patients over the course of forty years, clearly illustrates all the sounds and murmurs discussed.
Successfully demonstrating how to balance modern technology with increased personal skill in history-taking and physical examination, Essentials of Bedside Cardiology With a Complete Course in Heart Sounds and Murmurs on CD, Second Edition, offers all physicians, novice and practiced alike, a rigorous and well-proven methodology for precisely diagnosing and treating the widest range of cardiac patients today.

Texte du rabat

Essentials of Bedside Cardiology, Second Edition, like the first edition, is designed for those who wish to balance technological advances with increased personal skill in history taking and physical examination. It is important to teach physicians that all technologies now in use for diagnosing cardiovascular disorders, such as echocardiography, can have false positive and false negative results. It is not always wise to rely on these technologies alone; indeed, they may not even be available in some settings. Even when the full panoply of up-to-date techniques is at the physician's disposal, the patient may not be a good candidate for an echocardiogram, or the technician or reader may not be well qualified, or the equipment itself may be substandard. Technology must be combined with physical examination to decide what is true and what is false. The practice of expert history taking and physical examination returns the physician to the actual patient, where the physician can feel like a "real doctor" rather than a mere interpreter of laboratory data. Essentials of Bedside Cardiology, Second Edition, strives to teach and not simply to tell the facts, relying on three basic methods derived from the psychology of teaching and learning: 1. Explain the facts. 2. Use a question and answer format-the Socratic method. 3. Provide tricks or mnemonics to help the reader remember the facts.

Contenu

Chapter 1. The Checklist in History Taking Advantages of a Checklist Reminder List History Etiologies Follow-Up Questions New York Heart Association Functional and Therapeutic Classification References Chapter 2. Cardiac Clues from Physical Appearance Skin Congenital and Acquired Facies Eyes Edema Extremities Chest and Respiration References Chapter 3. Arterial Pulses and Pressures Method of Arm Palpation Rates of Rise and Pulse Volume Pulsus Bisferiens Palpation of the Leg Pulses Estimating Systolic Blood Pressure by Palpation Alone Accurate Blood Pressure Measurement Korotkoff Sounds Chest Piece Placement and Choice Equipment Sources of Error Systolic Pressure Measurement Diastolic Blood Pressure Recording Accuracy of Blood Pressure Recording Summary of How to Take Arm Blood Pressures by Listening for Korotkoff Sounds Pseudohypertension Pulsus Alternans Blood Pressure and Pulses in the Legs Pulsus Paradoxus Capillary Pulsation Abdominal Aortic Aneurysm (AAA) How to Tell Cardiac Function by Blood Pressure Response to a Valsalva Maneuver References Chapter 4. Jugular Pressure and Pulsations Venous Pressure by Jugular Inspection How to Use the Internal Jugulars as a Manometer Method of Obtaining an Accurate Measurement of Venous Pressure How to Tell Jugular from Carotid Pulsations The Abdominal Compression Test (Hepatojugular Reflux) Jugular Pulse Contours References Chapter 5. Inspection and Palpation of the Chest Ventricular Enlargement from Examination of the Chest Cardiac Dilatation Signs in the Left Lateral Decubitis Position Right Ventricular Enlargement Left-Sided Causes of Left Parasternal Movement X-ray Evaluation of Cardiac Size Diagnosis of VentricularHypertrophy by Physical Examination of the Precordium References Chapter 6. The Stethoscope The Bell Chest Piece The Smooth Diaphragm The Tubing Air Leaks and Ear Tips Summary of Good Stethoscope Characteristics References Chapter 7. Diagramming and Grading Heart Sounds and Murmurs The Auscultogram Grading of Heart Sounds and Murmurs References Chapter 8. The First Heart Sound (S1) Physiology of the First Sound Components The M1 Plus Aortic Ejection Sound as the Cause of a Split S1 The Pulmonary Ejection Sound Loudness of the M1. References Chapter 9. The Second Heart Sound (S2) Physiology and Nomenclature for the S2 Explanation of Normal Splitting Sequence of S2 Physiology of the Normally Moving Split Loudness of the Components of S2 The Widely Split S2 The A2-P2 in Pulmonary Stenosis ASDs with Narrow Splits. Differential Diagnosis of the Fixed Split The Narrowly Split S2 The S2 Split in Pulmonary Hypertension The Reversed or Paradoxically Split S2 References Chapter 10. The Opening Snap Mechanism and Timing Relation Between the 2-OS Interval and the Severity of Mitral Stenosis The Loudness of the Opening Snap How to Tell an A2-P2 from an A2-OS References Chapter 11. The Third Heart Sound (S2) Nomenclature Timing Mechanism of Production The Physiological S3 Loudness of the S3 The Exaggerated Physiological S3 The Pathological S3 The Physiological Versus the Pathological S3 The Right Versus the Left Ventricular S3 The S3 Versus the Opening Snap References Chapter 12. The Fourth Heart Sound (S4) Nomenclature Mode of Production Recognizing the Rhythm of the S4 Gallop The Physiological S4 The Pathological S4 Loudness and A