23. THE HEART AND CIRCULATION 2 ;PROFESSIONAL ENGLISH IN USE FOR MEDICINE

PROFESSIONAL ENGLISH IN USE FOR MEDICINE

23. THE HEART AND CIRCULATION 2

A

Physical examination Medical examination is normally carried out in four stages: inspection (looking), palpation (feeling with the hands), percussion (tapping with a finger) and auscultation (listening with a stethoscope).

B

Examining the heart and circulation Here is an extract from a textbook description of how to examine the cardiovascular system. Look at the lips, tongue and nails for the blue discoloration of cyanosis. Cyanosis may be central or peripheral. Inspect the hands for clubbing. Feel the radial pulse at the wrist and note the rate (for example 70/min) and rhythm (regular or irregular). The pulse may be irregular in force as well as time. Check that the other peripheral pulses are present. Measure the blood pressure, and assess the jugular venous pressure (JVP). Palpate the chest for the apex beat  - the normal position is the fifth left intercostal space, one centimetre medial to the midclavicular line. Feel for any thrills. Heart size may be measured by percussion. Listen for murmurs and other abnormal sounds, for example friction rubs, beginning at the mitral area. Murmurs may be soft or loud. A harsh murmur is loud and rough. Note the time of any murmur in relation to the cardiac cycle. The most common murmurs are 1 mid-systolic (in the middle of the systole) 2 pan-systolic (lasting for the whole of systole) 3 early diastolic 4 mid-diastolic 5 late diastolic Continue by listening at the tricuspid, aortic and pulmonary areas.

23.1	Complete the table with words from A opposite. Put a stress mark in front of the stressed syllable in each word. The first one has been done for you. Verb Noun ‘auscultate examine inspect palpate percuss
23.2	Put the steps for examining the heart and circulation in order, according to the four-stage system. Look at A opposite to help you. a Measure the heart size b Are there any murmurs? c Feel the radial pulse. d Look for clubbing. e Locate the apex beat. f Note any thrills
23.3	A doctor is presenting the case of a 43-year-old woman at a meeting in the Cardiology Department. Complete the text of her presentation. Look at B opposite to help you. On examination she was physical with a temperature of 38.5. She was short of breath. Her pulse was variable between 100 and 180 and was irregular in time and (1)__________. Her blood pressure was 130/80 and her JVP was up 5 centimetres showing normal movement with respiration. Her peripheral (2)__________ were all present and there was no (3)__________ or (4)__________ cyanosis. Her apex (5)__________ was displaced to the anterior axillary line but still in the fifth intercoastal (6)__________. Her heart sounds were very interesting. When she was initially examined it was noted that she had pan-systolic and mid-diastolic (7)__________, heard best at the apex. When she was examined some hours later, there was a harsh pericardial friction (8)__________ all over the precordium. Our diagnosis that time was of mitral stenosis and incompetence with a recent onset of pericarditis and atrial fibrillation.

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