**3.5 Radiography**

*Advances in Complex Valvular Disease*

development of atrial fibrillation.

is the cause of all the above.

*3.3.1 General appearance*

**3.3 Physical exam**

*3.3.2 Vital signs*

*3.3.2.1 Tachycardia*

*3.3.3 Pulse volume, contour*

*3.3.3.1 Auscultatory findings*

is particularly helpful.

**3.4 Electrocardiography**

The sensation of a rapid or unusually vigorous heartbeat may signal the

In hospitalised patients, excess extra cellular fluid is first presented as pitting oedema overlying the sacrum predominantly; the elevated systemic venous pressure

The toxic appearance of acute infection, wasting of cardiac cachexia, the distressed facial expression, wet cough, accessory muscle use, and diaphoresis of

Skin and mucosa cyanosis of the lips cold sweat (Osler nodes). (Janeway lesions), painless red macule lesions of the palms and soles (Janeway lesions), conjunctive petechial, and subungual hematomas (splinter haemorrhages).

Central venous pulsations jugular venous pulsation and mean central venous pressure (CVP) are often abnormal in valvular heart disease. In most cases, right heart failure is secondary left-sided valve disease-causing left heart failure. Less direct clues to the level of right atrial pressure; include the presence of pedal oedema, sacral oedema, anasarca, tender hepatomegaly, ecchymosis (hepatic

However, auscultation technical skill like any other and improves with repetition [29]. Therefore, students' physicians-in-training reading this text should lose heart, but rather, should apply themselves diligently to acquire these valuable bedside skills. Listening to patients before and after echocardiographic findings are known

In majority of patients with aortic valve disease with have abnormal ECG which commonly non-specific such as left ventricle hypertrophy, with or without repolarization abnormalities is seen on electrocardiography (ECG). Left atrial enlargement, left axis deviation and conduction disorders are also common. Atrial fibrillation can be seen at late state and in older patients or those with hypertension.

pulmonary oedema, and the cool skin characteristic of poor perfusion.

synthetic dysfunction), hepatojugular pulsation and ascites.

Maybe the initial manifestation of valvular heart disease.

*3.2.4 Weight gain, oedema, and abdominal discomfort*

*3.2.2 Palpitations*

*3.2.3 Angina*

**20**

Pulmonary vascular congestion. Enlargement, valvular calcification, and type position of prosthetic valve may all be ascertained plain radiographs. Comparing changes over time particularly helpful; hence obtaining previous studies is very valuable (**Figure 2**).
