CARDIOLOGY MODULE-2ND YEAR

JOHN N. HAMATY D.O.PROGRAM DIRECTOR

INTRODUCTION

COURSE OUTLINE OBJECTIVES LECTURE MATERIAL FINAL EXAM

INTRODUCTION

John Hamaty, D.O. FACC, FACOI

CONTACT INFORMATION:

63 Kresson RoadCherry Hill, New JerseyTEL: (856) 755-1173

EMAIL: cardiologyfellowship@sjhg.org

CARDIAC EXAM

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.

CARDIAC AUSCULTATION

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