Bates' Pocket Guide to Physical Examination and History Taking by Bickley Lynn

Author:Bickley, Lynn [Bickley, Lynn]
Language: eng
Format: epub
ISBN: 9781469819235
Publisher: Lippincot (Wolters Kluwer Health)
Published: 2012-10-07T22:00:00+00:00

Aids to Interpretation

Table 8-1 Chest Pain

Table 8-2 Dyspnea

Table 8-3 Cough and Hemoptysis

Table 8-4 Deformities of the Thorax

Table 8-5 Physical Findings in Selected Chest Disorders

CHAPTER 9

The Cardiovascular System

The Health History

Common or Concerning Symptoms

Chest pain

Palpitations

Shortness of breath: dyspnea, orthopnea, or paroxysmal nocturnal dyspnea

Swelling or edema

As you assess reports of chest pain or discomfort, keep serious adverse events in mind, such as angina pectoris, myocardial infarction, or even a dissecting aortic aneurysm. Ask also about any associated palpitations, orthopnea, paroxysmal nocturnal dyspnea (PND), and edema.

• Palpitations are an unpleasant awareness of the heartbeat.

• Shortness of breath may represent dyspnea, orthopnea, or PND.

• Dyspnea is an uncomfortable awareness of breathing that is inappropriate for a given level of exertion.

• Orthopnea is dyspnea that occurs when the patient is lying down and improves when the patient sits up. It suggests left ventricular heart failure or mitral stenosis; it also may accompany obstructive pulmonary disease.

• PND describes episodes of sudden dyspnea and orthopnea that awaken the patient from sleep, usually 1 to 2 hours after going to bed, prompting the patient to sit up, stand up, or go to a window for air.

• Edema refers to the accumulation of excessive fluid in the interstitial tissue spaces; it appears as swelling. Dependent edema appears in the feet and lower legs when sitting or in the sacrum when bedridden.

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