Essentials of Cardiac Physical Diagnosis

502 Pages·1987·29.36 MB·English

by  Jonathan Abrams

ESSENTIALS OF CARDIAC PHYSICAL

DIAGNOSIS

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ABOUT THE COVER
s
The heart on the cover of this book is an original drawing by Jim Dine, one of America
outstanding contemporary artists. Since entering the American art scene in the Pop Art
movemenl of the Iiarly 1960s, Afr. Dine has earned rt:cognition worldwide. Sr.:uer(,1 themes
have reappeared throughout his work over the past two decades, including home arid garden
tools, bathrobes, trees, and hearts. The heart represents a very personal image for Mr. Dine,
and he is perhaps best known for his heart paintings. assemblages, and sculptures.
II
ESSENTIALS OF CARDIAC PHYSICAL
DIAGNOSIS
JONATHAN ABRAMS, M.D.

Professor of Medicine; Chief,

Division of Cardiology; The University

of New Mexico School of Medicine,

Albuquerque, New Mexico

Lea & Febiger Philadelphia
1987
Lea & Fehiger
600 Washington Square
Philadelphia, PA 19106-4198
USA
[phone]
Library of Congress Cataloging-in-Publication Data
Abrams, Jonathan.
Essentials of cardiac physical diagnosis.
Includes bibliographies and index.
I
1. Heart-Examination. 2. Heart-Diseases­
Diagnosis. 3. Physical diagnosis. 1. Title.
[DNLM: 1. Heart Diseases-diagnosis. WG 141 A161e]
RC683.5.A9A27 1987 616.1'207'54 86-20175
ISBN 0-8121-1038-2
Copyright © 1987 by Lea & Febiger. Copyright under the International Copyright Union.
All Rights Reserved. This book is protected by copyright. No part of it may be reproduced in
any manner or by any means without written permission of the Publisher.
Printed in the United States of America
Print Number: 5 4 3 2 1
Dedication
I dedicate this book to W. Proctor Harvey, M.D., and Joseph K. Perloff,
M.D.; twooutstanding~teachers whose_ commitment to teaching cardiovas­
cular physical diagnosis is inspirational. They have stimulated and nurtured
a devotion to careful bedside skills in hundreds of students. Some, including
myself, have aspired to become disciples as well.
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Foreword
I am very pleased to be asked by Dr. Jonathan Abrams to write the
foreword to his book "Essentials of Cardiac Physical Diagnosis." In this era
of high technoiogy in cardiovascular diagnosis, it is imperative that the cli­
nician recognize that the cardiac diagnostic evaluation begins at the bedside
with the cardiac physical examination. This basic diagnostic tool is both an
art and a science. The art is based on practice, experience, and attention to
detail, while the science has its foundation in the anatomic, hemodynamic,
and physical principles that ,have been so clearly elucidated during the past
three decades. In this text, dedicated entirely to cardiac physical diagnosis,
Dr. Abrams incorporates both of these elements-the art being a product of
years of careful personal observation and experience, and the science based
on his thorough understanding of the mechanisms of production of cardiac
physical findings.
In the first 12 chapters of this book, the specific findings of the exam­
inations in normal and abnormal cardiac conditions are reviewed, with em­
phasis on their physiologic bases. In each chapter, the text is complemented
by carefully selected phonocardiograms and pulse tracings from the author's
personal file as well as from the cardiovascular literature. These recordings
of the arterial, venous, and precordial pulsations, together with the auscul­
tatory findings in various cardiac conditions, graphically demonstrate what
is seen, felt, and heard at the bedside. The author has also made liberal use
of pressure tracings and echocardiograms to give the reader a better under­
standing of the hemodynamic and anatomic abnormalities responsible for
certain physical findings. In the remaining 11 chapters, the physical findings
in common cardiac structural abnormalities are reviewed in detail, with the
salient feature of each condition graphically displayed by pulse recordings
and phonocardiograms.
This book should be a resource for students and house ofn.cers of general
internal medicine and a definitive reference for the practicing cardiologist.
Dr. Abrams' technique of highlighting important clinical points (practical
points) is most helpful for the student. For the more seasoned clinician, the
extensive correlation of physical findings in various cardiovascular conditions
with recent hemodynamic and echocardiographic studies affords further in­
sight into the underlying pathologic process, thereby making the detection
of the specific physical finding even more meaningful in cardiac diagnosis.
Included in each chapter are many clinical pearls. Such bedside subtleties as
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Essentials of Cardiac Physical Dignosis
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the presystolic murmur of mitral stenosis and its association with short cycle
lengths in atrial fibrillation, the absence of augmentation of t.he murmur of
tricuspid regurgitation with inspiration when severe right ventricular failure
is present, the technique of palpating a peripheral pulse after the assumption
of the upright posture to exaggerate the finding of pulsus alternans, and the
decrease in the pulse pressure following a long pause after a premature
ventricular contraction in patients with hypertrophic cardiomyopathy are but
a few examples of the gems presented in every chapter.
This book is a completely updatedrefer-ence for cardiac physical diag­
nosis, in which all of the normal and abnormal cardiac findings of the physical
examination are reviewed in great depth and put into appropriate perspective
in the light of recent scientific data. The physician who fully appreciates and
practices the principles of the cardiac physical examination as presented in
this book will be identified as an individual who has truly mastered the
discipline of clinical bedside cardiology.
James A. Shaver, M.D.
Professor of Medicine
Director, Division of Cardiology
University of Pittsburgh