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

2. INTRODUCTION COURSE OUTLINE COURSE OUTLINE OBJECTIVES OBJECTIVES LECTURE MATERIAL LECTURE MATERIAL FINAL EXAM FINAL EXAM

3. INTRODUCTION John Hamaty, D.O. FACC, FACOI CONTACT INFORMATION: 63 Kresson Road Cherry Hill, New Jersey TEL: (856) 755-1173 EMAIL: cardiologyfellowship@sjhg.org

4. CARDIAC EXAM CARDIAC EXAM

5. INSPECTION OF THE CHEST INSPECTION OF THE CHEST FIRST PART OF ANY PHYSICAL FIRST PART OF ANY PHYSICAL STANDING, SITTING AND LYING STANDING, SITTING AND LYING CHEST MORPHOLOGY CHEST MORPHOLOGY CARDIOVASCULAR PULSATIONS-APEX CARDIOVASCULAR PULSATIONS-APEX

8. PALPATION PALPATION RIGHT SIDE OF SUPINE PATIENT RIGHT SIDE OF SUPINE PATIENT USE FINGERTIPS USE FINGERTIPS TIME USING SIMULTANEOUS PALPATION OF THE CAROTID PULSE TIME USING SIMULTANEOUS PALPATION OF THE CAROTID PULSE CHEST EXPOSED AND 30 DEGREES WITH PATIENT LATERAL DECUB. CHEST EXPOSED AND 30 DEGREES WITH PATIENT LATERAL DECUB.

10. CARDIAC AUSCULTATION CARDIAC AUSCULTATION

11. GENERAL PRINCIPLES 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 VIBRATIONS ON THE SURFACE OF CHEST SET INTO MOTION A COLUMN OF AIR THAT IS COLLECTED AND CONDUCTED TO THE EAR BY THE STETHOSCOPE

12. STETHOSCOPE STETHOSCOPE THE MOST EFFECTIVE STETHOSCOPES ARE MADE OF PLASTIC TUBING 10-12 INCHES LONG WITH INTERNAL DIAMETER OF 1/8 IN. 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. BELL AND DIAPHRAGM TO COLLECT SOUND.

14. STETHOSCOPE STETHOSCOPE HIGH-FREQUENCY SOUNDS-S1 AND S2, SYSTOLIC CLICKS AND HIGH- PITCHED MURMURS ARE HEARD BEST WITH THE DIAPHRAGM. 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 THE BELL IS APPLIED LIGHTLY TO CHEST TO PREVENT AMBIENT NOISE BELL IS FOR LOW FREQUENCY-3 RD AND 4 TH SOUNDS, DIASTOLIC MURMURS. BELL IS FOR LOW FREQUENCY-3 RD AND 4 TH SOUNDS, DIASTOLIC MURMURS.

17. HEART SOUNDS HEART SOUNDS FIRST HEART SOUND: 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 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.

18. FIRST HEART SOUND TWO COMPONENTS TWO COMPONENTS INITIAL COMPONENT IS THE MOST PROMINENT AT THE APEX. THIS REPRESENTS MITRAL VALVE CLOSURE. 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 4 TH LEFT INTERCOSTAL SPACE. SECOND PORTION OF S1 IS CLOSURE OF TRICUSPID VALVE AND HEARD BEST AT 4 TH LEFT INTERCOSTAL SPACE.

20. FIRST HEART SOUND OPENING OF THE AORTIC AND PULMONIC VALVES ALSO OCCURS DURING S1 BUT IS USUALLY SILENT. 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. USUALLY A SINGLE SOUND. IT CAN BE SPLIT, ACCUNTUATED OR PARADOXICALLY SPLIT IN CERTAIN DISEASE STATES.

21. THE SECOND HEART SOUND THE FIRST COMPONENT AORTIC VALVE CLOSURE THE FIRST COMPONENT AORTIC VALVE CLOSURE THE SECOND COMPONENT IS PULMONIC VALVE CLOSURE THE SECOND COMPONENT IS PULMONIC VALVE CLOSURE INSPIRATORY SPLITTING OF S2 IS DUE TO DELAY IN PULMONIC COMPONENT INSPIRATORY SPLITTING OF S2 IS DUE TO DELAY IN PULMONIC COMPONENT

22. THIRD HEART SOUND Low frequency diastolic sounds that originate from the ventricles(Rt/Lt) Low frequency diastolic sounds that originate from the ventricles(Rt/Lt) Occur during rapid filling of ventricle Occur during rapid filling of ventricle Occurs as passive ventricular filling begins after actual relaxation is complete Occurs as passive ventricular filling begins after actual relaxation is complete Therefore it occurs just after S2 Therefore it occurs just after S2 Heard best with the bell. Heard best with the bell. Left lateral position Left lateral position

24. FORTH HEART SOUND Occurs after P wave on ecg. Occurs after P wave on ecg. Suggested that the atrial contribution is enhanced to overcome LV filling pressures. Suggested that the atrial contribution is enhanced to overcome LV filling pressures. Atrial “Kick” against a noncompliant ventricle Atrial “Kick” against a noncompliant ventricle Heard best with bell Heard best with bell Left lateral position Left lateral position