Cardiovascular System

Name:
Age Sex: Address:

PRESENTING ILLNESS
Breathlessness on Exertion
Onset, duration,
progress (class 1-4)
NYHA classification
Class INo limitation of
Class II-Mild limitation physical activity in spite of presence of heart disease
Class II1-Moderate limitation but not at rest
Class
IV-Symptoms at rest
Aggravating/relieving factors
Associated symptoms like
cough with expectoration, wheeze, chest pain
History of paroxysmal nocturnal dyspnea,
orthopnea, trepopnea, platypnea.
Chest Pain
Onset, site, duration, radiation, brought on
by, lasts for, character
Aggravating/relieving
Associated
factors
symptoms like vomiting, sweating, nausea, heart burns
Associated with food intake,
respiration.
Palpitation
Duration, brought on by, regular/irregular, relieved by, associated symptoms like chest pain, syncope.
Syncope
Duration, number of episodes, brought on by, relieved by, recovery time, associated
with
bowel disturbances. convulsions, bladder /
Swelling of Feet
Limited to face/legs-unilateral or bilateral/abdomen/generalized, agEravating/relieving factors, duration
Hemoptysis
Number of episodes, amount, color, sputum present or not.

Sputum
Duration, quality-frothy/viscid or thick, postural/diurnal variation
Quantity-copious, foul smelling.
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Mitral area: oud S1
.S1
(soft/N/loud), s2 audible Candac output
Added sounds ($3, S4, OS,
non-ejection click, pericardial knock)
Murmers, pericardial rub.
Tricuspid area: Paregvoma
$1
(soft/N/loud), s2 audible
Added sounds, murmers
(look for Carvallo's sign), rub.
Pulmonary area:
S 1 audible, $2 Ta Jny candka
(soft/N/loud), S2 splitting (wide, fixed, reverse, narrow)
Added sounds
Murmers.
(ejection clicks)
Aortic area: annlma
S1 audible, $2
Added sounds
(soft/N/loud)
(ejection click)
Murmers.
Examination of other
Systems
Respiratory system: Fine basal
Gastrointestinal crepitations, pleural effusion
systems: Tender hepatomegaly,
Central nervous
system: Chorea, hemiplegia splenomegaly, ascites
(embolism).

MITRAL STENOSIS
--------

HEMODYNAMICS
Mitral stenosis results in
Left atrium
obstruction to flow of blood across the mitral valve
compensates
for the during left ventricular diastole
Hypertrophy of LA (Left atrium).obstruction by increasing its pressure.
As LA is thin
walled, capacity for
LA pressure transmitted hypertrophy is limited.
to
There is increase in pulmonary vein (as there is no valve betweern them).
pulmonary venous pressure.
Pulmonary capillary engorgement and pulmonary
congestion
pulmonary arterial pressure-pulmonary arteriat (dyspnea).
Increase in
With mild
or moderate
MS-forward flow across mitral valvehypertension.
remains normal.
Severe MS-flow to left
Cardiac output
ventricle decreases.
decreases-small volume pulse2cold.extremities-peripheral
cyanosis.
NATURAL COURSE OF THE DISEASE
Young age DOE (20-25 years of age, more females)
Hemoptysis, PND
Middle age Palpitation at rest (due to AF)

Elderly Death (45-50 years)

If the initial symptom is

Dyspnea+ angina-MS+AS
OE+palpitation-MS +MR.