cardiology module-2 nd year john n. hamaty d.o. program director
TRANSCRIPT
INTRODUCTION
John Hamaty, D.O. FACC, FACOI
CONTACT INFORMATION:
63 Kresson RoadCherry Hill, New JerseyTEL: (856) 755-1173
EMAIL: [email protected]
INSPECTION OF THE CHEST
FIRST PART OF ANY PHYSICAL STANDING, SITTING AND LYING CHEST MORPHOLOGY CARDIOVASCULAR PULSATIONS-
APEX
PALPATION
RIGHT SIDE OF SUPINE PATIENT USE FINGERTIPS TIME USING SIMULTANEOUS
PALPATION OF THE CAROTID PULSE CHEST EXPOSED AND 30
DEGREES WITH PATIENT LATERAL DECUB.
GENERAL PRINCIPLES
VIBRATIONS ON THE SURFACE OF CHEST SET INTO MOTION A COLUMN OF AIR THAT IS COLLECTED AND CONDUCTED TO THE EAR BY THE STETHOSCOPE
STETHOSCOPE
THE MOST EFFECTIVE STETHOSCOPES ARE MADE OF PLASTIC TUBING 10-12 INCHES LONG WITH INTERNAL DIAMETER OF 1/8 IN.
BELL AND DIAPHRAGM TO COLLECT SOUND.
STETHOSCOPE
HIGH-FREQUENCY SOUNDS-S1 AND S2, SYSTOLIC CLICKS AND HIGH-PITCHED MURMURS ARE HEARD BEST WITH THE DIAPHRAGM.
THE BELL IS APPLIED LIGHTLY TO CHEST TO PREVENT AMBIENT NOISE
BELL IS FOR LOW FREQUENCY-3RD AND 4TH SOUNDS, DIASTOLIC MURMURS.
HEART SOUNDS
FIRST HEART SOUND: Occurs before palpable arterial
upstroke of the carotid and can be distinguished from S2, which occurs immediately after peak of carotid pulse
Heard best medial to apex at lower left sternal border.
FIRST HEART SOUND
TWO COMPONENTS INITIAL COMPONENT IS THE MOST
PROMINENT AT THE APEX. THIS REPRESENTS MITRAL VALVE CLOSURE.
SECOND PORTION OF S1 IS CLOSURE OF TRICUSPID VALVE AND HEARD BEST AT 4TH LEFT INTERCOSTAL SPACE.
FIRST HEART SOUND
OPENING OF THE AORTIC AND PULMONIC VALVES ALSO OCCURS DURING S1 BUT IS USUALLY SILENT.
USUALLY A SINGLE SOUND. IT CAN BE SPLIT, ACCUNTUATED OR PARADOXICALLY SPLIT IN CERTAIN DISEASE STATES.
THE SECOND HEART SOUND
THE FIRST COMPONENT AORTIC VALVE CLOSURE
THE SECOND COMPONENT IS PULMONIC VALVE CLOSURE
INSPIRATORY SPLITTING OF S2 IS DUE TO DELAY IN PULMONIC COMPONENT
THIRD HEART SOUND
Low frequency diastolic sounds that originate from the ventricles(Rt/Lt)
Occur during rapid filling of ventricle Occurs as passive ventricular filling
begins after actual relaxation is complete
Therefore it occurs just after S2 Heard best with the bell. Left lateral position
FORTH HEART SOUND
Occurs after P wave on ecg. Suggested that the atrial contribution is
enhanced to overcome LV filling pressures.
Atrial “Kick” against a noncompliant ventricle
Heard best with bell Left lateral position