The Art and Science of Cardiac Physical Examination: With Heart Sounds and Pulse Wave Forms on CD / Edition 1

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A panel of academic clinicians brings the art and science of the clinical cardiac examination to the bedside with a tour de force tutorial on the techniques needed to elicit various physical signs and to interpret them in relation to the patient's symptoms and underlying cardiac condition. Drawing on twenty-five years of teaching and training physicians and physicians-to-be, the authors integrate the physiology, pathophysiology, and mechanisms behind the various physical signs with a thorough and easy-to-use practical approach that makes physician feel more comfortable and competent performing the cardiac physical examination. The authors pay particular attention to the interpretation of the jugular venous pulsations and contour and make the physiology and pathophysiology of the normal and abnormal arterial pulse interesting and relevant. A unique and original companion video CD presents close to 140 clinical examples taken from actual patients, complete with audio recordings of various heart sounds and murmurs displayed in real time as seen on an oscilloscope. Additional video recordings show both precordial pulsations and jugular pulsations from patients with a variety of cardiac lesions, and illustrate certain unusual clinical conditions through simultaneous echocardiographic images and recordings of heart sounds and murmurs.

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Product Details

  • ISBN-13: 9781617377709
  • Publisher: Springer-Verlag New York, LLC
  • Publication date: 11/9/2010
  • Series: Contemporary Cardiology Series
  • Edition description: Softcover reprint of hardcover 1st ed. 2007
  • Edition number: 1
  • Pages: 430
  • Product dimensions: 7.00 (w) x 9.90 (h) x 1.10 (d)

Table of Contents

Chapter 1. Approach to the Physical Examination of the Cardiac Patient

Reasons for Which Cardiac Assessment Is Sought

Cardiac Symptoms and Their Appraisal

Generation of Working List of Possible Diagnoses

Focused Physical Examination: Clinical Exercise

Focused Physical Examination: Practical Points

Chapter 2. Arterial Pulse

Physiology of the Arterial Pulse

Assessment of the Arterial Pulse

Practical Points in the Clinical Assessment of the Arterial Pulse


Chapter 3. Blood Pressure and Its Measurement

Physiology of Blood Flow and Blood Pressure

Physiology of Blood Pressure Measuremen

Points to Remember When Measuring Blood Pressure

Factors That Affect Blood Pressure Readings

Interpretation of Blood Pressure Measurements

Use of Blood Pressure Measurement in Special Clinical Situations


Chapter 4. Jugular Venous Pulse

Normal Right Atrial Pressure Pulse Contours

Jugular Venous Inflow Velocity Patterns and the Relationship to the Right Atrial Pressure Pulse

Jugular Venous Flow Events and Their Relationship to Jugular Venous Pulse Contours

Normal Jugular Venous Pulse Contour and Its Recognition at the Bedside

Individual Components of the Right Atrial Pressure Pulse, Their Determinants, and Their Recognition in the Jugulars

Abnormal Jugular Venous Pulse Contours as Related to Abnormal Jugular Venous Flow Velocity Patterns

Abnormal Jugular Contours

Assessment of Jugular Venous Pressure

Clinical Assessment of the Jugular Venous Pulse


Chapter 5. Precordial Pulsations

Mechanics and Physiology of the Normal Apical Impulse

Physical Principles Governing the Formation of the Apical Impulse

Normal Apical Impulse and Its Determinants

Assessment of the Apical Impulse

Left Parasternal and Sternal Movements

Right Parasternal Movement

Pulsations Over the Clavicular Heads

Pulsations Over the Second and/or Third Left Intercostal Spaces

Subxiphoid Impulse

Practical Points in the Clinical Assessment of Precordial Pulsations


Chapter 6. Heart Sounds

Principles of Sound Formation in the Heart

First Heart Sound (S1)

Clinical Assessment of S1 and Components

Second Heart Sound (S2)

Normal S2

Abnormal S2

Clinical Assessment of S2

Opening Snap (OS)

Third Heart Sound (S3)

Clinical Assessment of S3

Fourth Heart Sound (S4)

Clinical Assessment of S4


Chapter 7. Heart Murmurs: Part I

Principles Governing Murmur Formation

Hemodynamic Factors and Cardiac Murmurs

Frequencies of Murmurs

Grading of Murmurs

Systolic Murmurs

Ejection Murmurs

Regurgitant Systolic Murmurs

Mitral Regurgitation

Tricuspid Regurgitation

Ventricular Septal Defect (VSD)

Clinical Assessment of Systolic Murmurs


Chapter 8. Heart Murmurs: Part II

Diastolic Murmurs

Diastolic Murmurs of Mitral Origin

Diastolic Murmurs of Tricuspid Origin

Semilunar Valve Regurgitation

Aortic Regurgitation

Pulmonary Regurgitation

Clinical Assessment of Diastolic Murmurs

Continuous Murmurs

Persistent Ductus Arteriosus

Aorto-Pulmonary Window

Sinus of Valsalva Aneurysm

Coronary Arteriovenous Fistulae

Venous Hum

Mammary Souffle

Clinical Assessment of Continuous Murmurs

Pericardial Friction Rub

Innocent Murmurs


Chapter 9. Elements of Auscultation

The Stethoscope

Auscultation Method


Chapter 10. Pathophysiological Basis of Symptoms and Signs in Cardiac Disease

Pathophysiology of Mitral Regurgitation

Pathophysiology of Aortic Regurgitation

Pathophysiology of Mitral Stenosis

Pathophysiology of Aortic Stenosis

Pathophysiology of Myocardial Ischemia/Infarction

Pathophysiology of Hypertensive Heart Disease

Pathophysiology of Dilated Cardiomyopathy

Pathophysiology of Hypertrophic Obstructive Cardiomyopathy

Pathophysiology of Atrial Septal Defect

Pathophysiology of Diastolic Dysfunction

Pathophysiology of Constrictive Pericarditis

Pathophysiology of Cardiac Tamponade



Chapter 11. Local and Systemic Manifestation of Cardiovascular Disease

General Observations

Congenital Syndromes/Diseases

Vascular Diseases

Valvular Heart Disease

Endocrine and Metabolic Diseases

Inflammatory Diseases

Diseases of Connective Tissue and Joints

Drug Therapy

Musculoskeletal Diseases




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