CARDIOLOGY MODULE-2ND YEAR JOHN N. HAMATY D.O. PROGRAM DIRECTOR

INTRODUCTION COURSE OUTLINE OBJECTIVES LECTURE MATERIAL FINAL EXAM

John Hamaty, D.O. FACC, FACOI INTRODUCTION John Hamaty, D.O. FACC, FACOI CONTACT INFORMATION: Noelle Folkman 1 Brace Road, Suite C Cherry Hill, New Jersey TEL: (856) 755-1173 EMAIL: sjhgcardiofellowship@gmail.com

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