Marfan's Syndrome Case Study

CARDIO-VASCULAR:
A) Inspection:
1. Scars : valve lesion, surgery - pacemaker box-under pec. muscle
2. Skeletal abnormalities : pectus escavatum(funnel chest) - Kyphoscoliosis - Marfan’s syndrome-move position of heart-move apex beat
3. Deformities: interfere pulmonary function – pulmonary hypertension
4. Apex beat : Normal position – 5th left intercostal space, 1cm medial midclavicular line
B) Palpitation:
1. Apex beat: - palpable apex beat above anatomical apex - palpable in 40% normal individuals - Character – normal – lift palpating finger
Abnormal apex beats:
i)
Parasternal impulses:
If palpable: RV or LA enlargement Pulmonary hypertension
3. Thrills/murmers:
Thrills – palpable murmers – turbulent bloodflow
• Systolic thrill: coincide with apex beat
• Diastolic thrill: not coincide with apex beat
C) Percussion: 5th intercostal space
D) Auscultation: (most NB in cardio examination)
1. Normal heart sounds:
S1: beginning ventricular systole – mitrial & tricuspid valve closure
S2: end of systole – softer, shorter, higher pitch - aortic & pulmonary valve closure (5th intercostal space)
2. Splitting: - closure of pulmonary valves later than aortic valves - 70% adults – splitting of 2nd heart sound - wider on inspiration, S2 beginning systole

3. Alterations in