CARDIOLOGY CARDIOLOGY MODULE-2MODULE-2NDND YEARYEAR

JOHN N. HAMATY D.O.JOHN N. HAMATY D.O.

PROGRAM DIRECTORPROGRAM DIRECTOR

INTRODUCTIONINTRODUCTION

COURSE OUTLINECOURSE OUTLINE OBJECTIVESOBJECTIVES LECTURE MATERIALLECTURE MATERIAL FINAL EXAMFINAL EXAM

INTRODUCTIONINTRODUCTION

John Hamaty, D.O. FACC, FACOIJohn Hamaty, D.O. FACC, FACOI

CONTACT INFORMATION:CONTACT INFORMATION:

3001 Chapel Ave,3001 Chapel Ave,Suite 101Suite 101

Cherry Hill NJ 08002Cherry Hill NJ 08002

TEL: (856) 755-1173TEL: (856) 755-1173

EMAIL: EMAIL: cardiologyfellowship@sjhg.orgcardiologyfellowship@sjhg.org

CARDIAC EXAMCARDIAC EXAM

INSPECTION OF THE INSPECTION OF THE CHESTCHEST

FIRST PART OF ANY PHYSICALFIRST PART OF ANY PHYSICAL STANDING, SITTING AND LYINGSTANDING, SITTING AND LYING CHEST MORPHOLOGYCHEST MORPHOLOGY CARDIOVASCULAR PULSATIONS-CARDIOVASCULAR PULSATIONS-

APEXAPEX

PALPATIONPALPATION

RIGHT SIDE OF SUPINE PATIENTRIGHT SIDE OF SUPINE PATIENT USE FINGERTIPSUSE FINGERTIPS TIME USING SIMULTANEOUS TIME USING SIMULTANEOUS

PALPATION OF THE CAROTID PULSEPALPATION OF THE CAROTID PULSE CHEST EXPOSED AND 30 DEGREES CHEST EXPOSED AND 30 DEGREES

WITH PATIENT LATERAL DECUB.WITH PATIENT LATERAL DECUB.

CARDIAC CARDIAC AUSCULTATIONAUSCULTATION

GENERAL PRINCIPLESGENERAL PRINCIPLES

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

STETHOSCOPESTETHOSCOPE

THE MOST EFFECTIVE THE MOST EFFECTIVE STETHOSCOPES ARE MADE OF STETHOSCOPES ARE MADE OF PLASTIC TUBING 10-12 INCHES PLASTIC TUBING 10-12 INCHES LONG WITH INTERNAL DIAMETER LONG WITH INTERNAL DIAMETER OF 1/8 IN.OF 1/8 IN.

BELL AND DIAPHRAGM TO BELL AND DIAPHRAGM TO COLLECT SOUND.COLLECT SOUND.

STETHOSCOPESTETHOSCOPE

HIGH-FREQUENCY SOUNDS-S1 AND HIGH-FREQUENCY SOUNDS-S1 AND S2, SYSTOLIC CLICKS AND HIGH-S2, SYSTOLIC CLICKS AND HIGH-PITCHED MURMURS ARE HEARD PITCHED MURMURS ARE HEARD BEST WITH THE DIAPHRAGM.BEST WITH THE DIAPHRAGM.

THE BELL IS APPLIED LIGHTLY TO THE BELL IS APPLIED LIGHTLY TO CHEST TO PREVENT AMBIENT NOISECHEST TO PREVENT AMBIENT NOISE

BELL IS FOR LOW FREQUENCY-3BELL IS FOR LOW FREQUENCY-3RDRD AND 4AND 4THTH SOUNDS, DIASTOLIC SOUNDS, DIASTOLIC MURMURS.MURMURS.

HEART SOUNDSHEART SOUNDS

FIRST HEART SOUND:FIRST HEART SOUND: Occurs Occurs before before palpable arterial palpable arterial

upstroke of the carotid and can be upstroke of the carotid and can be distinguished from S2, which occurs distinguished from S2, which occurs immediately immediately after after peak of carotid peak of carotid pulsepulse

Heard best medial to apex at lower Heard best medial to apex at lower left sternal border. left sternal border.

FIRST HEART SOUNDFIRST HEART SOUND

TWO COMPONENTSTWO COMPONENTS INITIAL COMPONENT IS THE MOST INITIAL COMPONENT IS THE MOST

PROMINENT AT THE APEX. THIS PROMINENT AT THE APEX. THIS REPRESENTS MITRAL VALVE REPRESENTS MITRAL VALVE CLOSURE.CLOSURE.

SECOND PORTION OF S1 IS SECOND PORTION OF S1 IS CLOSURE OF TRICUSPID VALVE CLOSURE OF TRICUSPID VALVE AND HEARD BEST AT 4AND HEARD BEST AT 4THTH LEFT LEFT INTERCOSTAL SPACE.INTERCOSTAL SPACE.

FIRST HEART SOUNDFIRST HEART SOUND

OPENING OF THE AORTIC AND OPENING OF THE AORTIC AND PULMONIC VALVES ALSO OCCURS PULMONIC VALVES ALSO OCCURS DURING S1 BUT IS USUALLY DURING S1 BUT IS USUALLY SILENT.SILENT.

USUALLY A SINGLE SOUND. IT CAN USUALLY A SINGLE SOUND. IT CAN BE SPLIT, ACCUNTUATED OR BE SPLIT, ACCUNTUATED OR PARADOXICALLY SPLIT IN CERTAIN PARADOXICALLY SPLIT IN CERTAIN DISEASE STATES.DISEASE STATES.

THE SECOND HEART THE SECOND HEART SOUNDSOUND

THE FIRST COMPONENT AORTIC THE FIRST COMPONENT AORTIC VALVE CLOSUREVALVE CLOSURE

THE SECOND COMPONENT IS THE SECOND COMPONENT IS PULMONIC VALVE CLOSUREPULMONIC VALVE CLOSURE

INSPIRATORY SPLITTING OF S2 IS INSPIRATORY SPLITTING OF S2 IS DUE TO DELAY IN PULMONIC DUE TO DELAY IN PULMONIC COMPONENTCOMPONENT