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Precordial Examination
In medicine, the cardiac examination, also precordial exam, is performed as part of a physical examination, or when a patient presents with chest pain suggestive of a cardiovascular pathology. It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination. Like all medical examinations, the cardiac examination follows the standard structure of inspection, palpation and auscultation. Positioning The patient is positioned in the supine position tilted up at 45 degrees if the patient can tolerate this. The head should rest on a pillow and the arms by their sides. The level of the jugular venous pressure (JVP) should only be commented on in this position as flatter or steeper angles lead to artificially elevated or reduced level respectively. Also, left ventricular failure leads to pulmonary edema which increases and may impede breathing if the patient is laid flat. Lighting should be adjusted so that it is n ...
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Medicine
Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others. Medicine has been practiced since prehistoric times, and for most of this time it was an art (an area of skill and knowledge), frequently having connections to the religious and philosophical beliefs of local culture. For example, a medicine man would apply herbs and say prayers for healing, o ...
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Xanthalasma
Xanthelasma is a sharply demarcated yellowish deposit of cholesterol underneath the skin. It usually occurs on or around the eyelids (''xanthelasma palpebrarum'', abbreviated XP). While they are neither harmful to the skin nor painful, these minor growths may be disfiguring and can be removed. There is a growing body of evidence for the association between xanthelasma deposits and blood low-density lipoprotein levels and increased risk of atherosclerosis. A xanthelasma may be referred to as a xanthoma when becoming larger and nodular, assuming tumorous proportions. Xanthelasma is often classified simply as a subtype of xanthoma. Diagnosis Xanthelasma in the form of XP can be diagnosed from clinical impression, although in some cases it may need to be distinguished (differential diagnosis) from other conditions, especially necrobiotic xanthogranuloma, syringoma, palpebral sarcoidosis, sebaceous hyperplasia, Erdheim–Chester disease, lipoid proteinosis (Urbach–Wiethe disease) ...
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Aortic Insufficiency
Aortic regurgitation (AR), also known as aortic insufficiency (AI), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. As a consequence, the cardiac muscle is forced to work harder than normal. Signs and symptoms Symptoms of aortic regurgitation are similar to those of heart failure and include the following: * Dyspnea on exertion * Orthopnea * Paroxysmal nocturnal dyspnea * Palpitations * Angina pectoris * Cyanosis (in acute cases) Causes In terms of the cause of aortic regurgitation, is often due to the aortic root dilation ('' annuloaortic ectasia''), which is idiopathic in over 80% of cases, but otherwise may result from aging, syphilitic aortitis, osteogenesis imperfecta, aortic dissection, Behçet's disease, reactive arthritis and systemic hypertension.Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease in: Aortic root dilation ...
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HOCM
Hypertrophic cardiomyopathy (HCM, or HOCM when obstructive) is a condition in which the heart becomes thickened without an obvious cause. The parts of the heart most commonly affected are the interventricular septum and the ventricles. This results in the heart being less able to pump blood effectively and also may cause electrical conduction problems. People who have HCM may have a range of symptoms. People may be asymptomatic, or may have fatigue, leg swelling, and shortness of breath. It may also result in chest pain or fainting. Symptoms may be worse when the person is dehydrated. Complications may include heart failure, an irregular heartbeat, and sudden cardiac death. HCM is most commonly inherited from a person's parents in an autosomal dominant pattern. It is often due to mutations in certain genes involved with making heart muscle proteins. Other inherited causes of left ventricular hypertrophy may include Fabry disease, Friedreich's ataxia, and certain medicati ...
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Aortic Stenosis
Aortic stenosis (AS or AoS) is the narrowing of the exit of the left ventricle of the heart (where the aorta begins), such that problems result. It may occur at the aortic valve as well as above and below this level. It typically gets worse over time. Symptoms often come on gradually with a decreased ability to exercise often occurring first. If heart failure, loss of consciousness, or heart related chest pain occur due to AS the outcomes are worse. Loss of consciousness typically occurs with standing or exercising. Signs of heart failure include shortness of breath especially when lying down, at night, or with exercise, and swelling of the legs. Thickening of the valve without narrowing is known as aortic sclerosis. Causes include being born with a bicuspid aortic valve, and rheumatic fever; a normal valve may also harden over the decades. A bicuspid aortic valve affects about one to two percent of the population. As of 2014 rheumatic heart disease mostly occurs in the dev ...
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Pulsus Alternans
Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis. Pathophysiology One explanation is that in left ventricular dysfunction, the ejection fraction will decrease significantly, causing reduction in stroke volume, hence causing an increase in end-diastolic volume. As a result, during the next cycle of systolic phase, the myocardial muscle will be stretched more than usual and as a result there will be an increase in myocardial contraction, related to the Frank–Starling physiology of the heart. This results, in turn, in a stronger systolic pulse. There may initially be a tachycardia as a compensatory mechanism to try to maintain cardiac output. Other explanation is due to the heterogeneity of the refractory period between the healthy and diseased myocardial cells. Diagnosis Begin by palpating the radial or femoral art ...
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Hypercapnia
Hypercapnia (from the Greek ''hyper'' = "above" or "too much" and ''kapnos'' = "smoke"), also known as hypercarbia and CO2 retention, is a condition of abnormally elevated carbon dioxide (CO2) levels in the blood. Carbon dioxide is a gaseous product of the body's metabolism and is normally expelled through the lungs. Carbon dioxide may accumulate in any condition that causes hypoventilation, a reduction of alveolar ventilation (the clearance of air from the small sacs of the lung where gas exchange takes place) as well as resulting from inhalation of CO2. Inability of the lungs to clear carbon dioxide, or inhalation of elevated levels of CO2, leads to respiratory acidosis. Eventually the body compensates for the raised acidity by retaining alkali in the kidneys, a process known as "metabolic compensation". Acute hypercapnia is called acute hypercapnic respiratory failure (AHRF) and is a medical emergency as it generally occurs in the context of acute illness. Chronic hypercapnia ...
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Aortic Regurgitation
Aortic regurgitation (AR), also known as aortic insufficiency (AI), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. As a consequence, the cardiac muscle is forced to work harder than normal. Signs and symptoms Symptoms of aortic regurgitation are similar to those of heart failure and include the following: * Dyspnea on exertion * Orthopnea * Paroxysmal nocturnal dyspnea * Palpitations * Angina pectoris * Cyanosis (in acute cases) Causes In terms of the cause of aortic regurgitation, is often due to the aortic root dilation ('' annuloaortic ectasia''), which is idiopathic in over 80% of cases, but otherwise may result from aging, syphilitic aortitis, osteogenesis imperfecta, aortic dissection, Behçet's disease, reactive arthritis and systemic hypertension.Chapter 1: Diseases of the Cardiovascular system > Section: Valvular Heart Disease in: Aortic root dilation ...
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Watson's Water Hammer Pulse
Watson's water hammer pulse, also known as Corrigan's pulse or collapsing pulse, is the medical sign (seen in aortic regurgitation) which describes a pulse that is bounding and forceful, rapidly increasing and subsequently collapsing, as if it were the sound of a water hammer that was causing the pulse. A water hammer was a Victorian toy in which a tube was half filled with fluid, the remainder being a vacuum. Each time the tube was inverted or shaken, the impact of the fluid at each end would sound like a hammer blow. This is associated with increased stroke volume of the left ventricle and decrease in the peripheral resistance leading to the widened pulse pressure of aortic regurgitation. Diagnosis To feel a water hammer pulse: with the patient reclining, the examiner raises the patient's arm vertically upwards. The examiner grasps the muscular part of the patient's forearm. A water hammer pulse is felt as a tapping impulse that is transmitted through the bulk of the muscles. Thi ...
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Carotid Pulse
In anatomy, the left and right common carotid arteries (carotids) (Entry "carotid"
in
Merriam-Webster Online Dictionary
'.) are that supply the head and neck with ; they divide in the neck to form the and



Radial Pulse
In human anatomy, the radial artery is the main artery of the lateral aspect of the forearm. Structure The radial artery arises from the bifurcation of the brachial artery in the antecubital fossa. It runs distally on the anterior part of the forearm. There, it serves as a landmark for the division between the anterior and posterior compartments of the forearm, with the posterior compartment beginning just lateral to the artery. The artery winds laterally around the wrist, passing through the anatomical snuff box and between the heads of the first dorsal interosseous muscle. It passes anteriorly between the heads of the adductor pollicis, and becomes the deep palmar arch, which joins with the deep branch of the ulnar artery. Along its course, it is accompanied by a similarly named vein, the radial vein. Branches The named branches of the radial artery may be divided into three groups, corresponding with the three regions in which the vessel is situated. In the forearm * Ra ...
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Median Sternotomy
Median sternotomy is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided using a sternal saw. This procedure provides access to the heart and lungs for surgical procedures such as heart transplant, lung transplant, corrective surgery for congenital heart defects, or coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced "cabbage") is a surgical procedure to treat coronary artery disease (CAD), the buildup of plaques in the arteries of the heart. It can relieve chest pai .... References {{Cardiac surgery Thoracic surgical procedures Surgical incisions ...
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