Essentials of Diagnosis

• Precordial chest pain, usually precipitated by stress or exertion, relieved rapidly by rest or nitrates.
• Electrocardiographic or scintigraphic evidence of ischemia during pain or stress testing.…

Coronary heart disease, or atherosclerotic coronary artery disease, is the commonest cause of cardiovascular disability and death in the United States. Men are more often affected than women by an…

Although many risk factors for coronary artery disease are not modifiable, it is now clear that interventions such as smoking cessation, treatment of dyslipidemia, and lowering of blood pressure…

Essentials of Diagnosis

Tricuspid regurgitation may occur in a variety of situations other than disease of the tricuspid valve itself. The most common is right ventricular overload resulting from left ventricular failure due to any cause. Tricuspid regurgitation…

Essentials of Diagnosis

• Variable causes determine clinical presentation.
• May be asymptomatic for many years (or for life) or may cause left-sided heart failure.
• Pansystolic murmur at the apex,…

Valve repair may be useful for tricuspid, mitral, and occasionally aortic regurgitation. Likewise, percutaneous or open valvulotomy may be indicated in mitral, pulmonary, and tricuspid stenosis. Nonetheless, the number of valve…

Tricuspid stenosis is usually rheumatic in origin. It should be suspected when “right heart failure” appears in the course of mitral valve disease, marked by hepatomegaly, ascites, and dependent edema. It may also occur in…

Essentials of Diagnosis

• Usually asymptomatic until middle age; presents with left-sided failure or chest pain.
• Wide pulse pressure with associated peripheral signs.
• Hyperactive, enlarged left ventricle.
• Diastolic murmur along left…

Essentials of Diagnosis

• In adults, usually asymptomatic until middle or old age.
• Delayed and diminished carotid pulses.
• Soft, absent, or paradoxically split S₂.
• Harsh systolic murmur, sometimes with thrill…

While most cases of valvular disease in the United States were at one time due to rheumatic heart disease (still true in developing countries), other causes are now more common. The typical findings of…

Essentials of Diagnosis

• Usually asymptomatic until middle age.
• Right ventricular lift; S₂ widely split and fixed.
• Grade I-III/VI systolic ejection murmur at pulmonary area.
• ECG…

Essentials of Diagnosis

• Adults asymptomatic if defect is small to moderate.
• Grade II-VI/VI pansystolic murmur maximal at the left sternal border; associated thrill common.
• ECG may show left ventricular hypertrophy…

Essentials of Diagnosis

• Adults with small or moderately large patent ductus are usually asymptomatic at least until middle age.
• Widened pulse pressure; loud S₂.
• Continuous murmur over pulmonary area; thrill…

Essentials of Diagnosis

• No symptoms in patients with mild or moderately severe lesions.
• Severe cases may present with right-sided heart failure and cause sudden death.
• High-pitched systolic ejection murmur maximal in…

Although the cardiovascular examination centers on the heart, peripheral signs are often invaluable.

In the management of patients with heart disease, it is important to quantify and closely follow the severity of symptoms. A commonly used classification system is that of the New York Heart…

Although cardiac catheterization and angiography remain the standard tests for assessment of many hemodynamic and anatomic abnormalities of the heart, they have often been supplanted by echocardiography and other imaging modalities for the…

The chest x-ray provides information about heart size, the pulmonary circulation (with characteristic signs suggesting both pulmonary artery or pulmonary venous hypertension), primary pulmonary disease, and aortic abnormalities. The echocardiogram provides much more…

Essentials of Diagnosis

• Infants may have severe heart failure; children and adults are usually asymptomatic, presenting with hypertension.
• Absent or weak femoral pulses.
• Systolic pressure higher in upper extremities…

The heart is the hollow, muscular organ in the thoracic cavity (chest) that maintains the circulation of blood throughout the body. It is surrounded by a membrane called the pericardium. The pericardium consists…

coronary artery disease (CAD) occurs when the arteries that supply blood to the heart muscle (coronary arteries) become hardened and narrowed. The arteries harden and become narrow due to the buildup of…

Atherosclerosis (ath-er-o-skle-RO-sis) is the hardening and narrowing of the arteries. It is caused by the slow buildup of plaque (plak) on the inside of walls of the arteries. Arteries are blood vessels that carry…