warning Note that these sounds are downloaded from various sites Flash videos are downloaded from: www.cardiologysite.com EKG are taken from yahoo images and various sites This is for educational purpose only as USMLE exams are getting difficult, I figured the best way to learn is make slides..hope it helps 4/12/2009 1 http://conceptclues.blogspot.com/

Name The Murmur 4/12/2009 2 http://conceptclues.blogspot.com/

Name the sound NAME THE SOUND..ANSWER IN NEXT SLIDE…click on the icon The most sensitive EKG changes: Diffuse ST segment elevation a very specific change is: depression of the PR segment in all leads EXCEPT aVR and V1. 4/12/2009 3 http://conceptclues.blogspot.com/

Same slide contiues Name the EKG 4/12/2009 4 http://conceptclues.blogspot.com/

ANSWER: ACUTE PERICARDITIS 4/12/2009 5 http://conceptclues.blogspot.com/

Name the sound Answer in next slide sharp sound heard on auscultation in early systole over the aortic or pulmonic area when the aorta or pulmonary artery is dilated 4/12/2009 6 http://conceptclues.blogspot.com/

Answer: Ejection click 4/12/2009 7 http://conceptclues.blogspot.com/

Name the sound split in the aortic (A2) and pulmonic (P2) components of the second heart sound during both inspiration and expiration 4/12/2009 8 http://conceptclues.blogspot.com/

Answer: Fixed Split S2 4/12/2009 9 http://conceptclues.blogspot.com/

Name the sound sound created by blood trying to enter a stiff, non-compliant left ventricle during atrial contraction. It's most frequently associated with left ventricular hypertrophy that is the result of long standing hypertension 4/12/2009 10 http://conceptclues.blogspot.com/

Answer Fourth heart sound 4/12/2009 11 http://conceptclues.blogspot.com/

Name the sound A crunching, rasping sound, synchronous with heartbeat, heard over the precordium and sometimes at a distance from the chest in spontaneous mediastinal emphysema. 4/12/2009 12 http://conceptclues.blogspot.com/

Answer: Hamman’s Crunch Hamman's crunch is caused by pneumomediastinum or pneumopericardium, and is associated with tracheobronchial injury[4] due to trauma, medical procedures (e.g., bronchoscopy) or proximal pulmonary bleb rupture. It is commonly seen in Boerhaave syndrome 4/12/2009 13 http://conceptclues.blogspot.com/

Name the Sound Follows opening snap Delayed rumbling late diastolic murmur LA>>LV pressure during diastole Often occurs secondary to rheumatic fever 4/12/2009 14 http://conceptclues.blogspot.com/

Answer Mid-Systolic Click most frequent cause of systolic clicks is prolapse of a mitral valve leaflet, in which case there may be an associated late systolic regurgitant murmur, sometimes called the click-murmur syndrome 4/12/2009 15 http://conceptclues.blogspot.com/

Name the sound When valve becomes leaky, blood may back up into the lungs, causing shortness of breath untreated leaky valve can lead to heart failure 4/12/2009 16 http://conceptclues.blogspot.com/

Answer Mitral Regurgitation 4/12/2009 17 http://conceptclues.blogspot.com/

What causes mitral valve regurgitation? There are two forms of mitral valve regurgitation: Acute: Develops quickly Can be life-threatening Happends when valves or nearby tissues are ruptured suddenly Blood builds up quickly and ur heart doesn’t have time to adjust Common causes: Heart attack Infection = endocarditits Chronic: Valve prone to wear and tear Blood builds up slowly Older person = weak valve Causes: Heart failure Rheumatic fever Congenital Calcium build up in valve 4/12/2009 18 http://conceptclues.blogspot.com/

Symptoms of Mitral Regurgitation If you have mild to moderate chronic mitral valve regurgitation, you may never have symptoms. If you have moderate to severe disease, you may not have symptoms for decades. If your heart weakens because of your mitral valve, you may start to have symptoms of heart failure. Call your doctor if you have any of these symptoms: Shortness of breath with activity, which later develops into shortness of breath at rest and at night. Extreme tiredness and weakness. A buildup of fluid in the legs and feet, called edema. Acute mitral valve regurgitation is an emergency. Symptoms come on rapidly and include severe shortness of breath at rest, coughing, and fast heartbeat. 4/12/2009 19 http://conceptclues.blogspot.com/

Mitral Regurgitation treatment Treatment for chronic cases includes regularly checking your heart to make sure it is working properly. Treatment also includes preventing infection and treating symptoms as they develop. Your doctor may have you take medicines, including: Vasodilators, such as ACE inhibitors, to help widen blood vessels and help the heart work better. Diuretics, to treat symptoms of heart failure and reduce the workload on your heart. Anticoagulants, such as warfarin (Coumadin), to prevent blood clots if you also have a heart rhythm problem called atrial fibrillation. Beta-blockers, antiarrhythmics, or calcium channel blockers, to control heart rate. You may need surgery to repair or replace your mitral valve if you get symptoms of heart failure, if the size of your left ventricle (your heart's main pumping chamber) increases, or if your heart weakens. 4/12/2009 20 http://conceptclues.blogspot.com/

Name This Sound causing blood to flow backward (leak) into the right upper heart chamber (atrium) when the right lower heart chamber (ventricle) contracts. most common cause = swelling of the right ventricle Other causes: Carcinoid tumors, which release a hormone which damages the valve Marfan syndrome Injury Rheumatoid arthritis Radiation therapy 4/12/2009 21 http://conceptclues.blogspot.com/

Answer Tricuspid Regurgitation 4/12/2009 22 http://conceptclues.blogspot.com/

Name this sound symptoms: Difficulty Breathing During or after exercise When lying flat (orthopnea ) Awakening at night with difficulty breathing Cough May have blood in the sputum (hemoptysis) Fatigue, tired easily Feet or ankle swelling Frequent respiratory infections (such as bronchitis ) Sensation of feeling the heart beat (palpitations ) Poor growth in children 4/12/2009 23 http://conceptclues.blogspot.com/

Answer Mitral Stenosis Mitral stenosis is associated with four auscultatory findings: loud S1, loud P2, an opening snap, and a diastolic murmur 4/12/2009 24 http://conceptclues.blogspot.com/

Name this sound In adults, three conditions are known to cause this murmur. Progressive wear and tear of a bicuspid valve present since birth (congenital). Wear and tear of the aortic valve in the elderly. Scarring of the aortic valve due to rheumatic fever as a child or young adult. Major symptoms: Chest pain (angina) Fainting (syncope) Shortness of breath ( due to heart failure) 4/12/2009 25 http://conceptclues.blogspot.com/

Answer Aortic Stenosis 4/12/2009 26 http://conceptclues.blogspot.com/

Name this sound Narrow valve Symptoms: Bluish skin (cyanosis) Chest pain Fainting Fatigure Poor weight gain or failure to thrive Shortness of breath Sudden death Possible Complications: Cyanosis Death Heart failure RVH 4/12/2009 27 http://conceptclues.blogspot.com/

Answer: Pulmonic Stenosis 4/12/2009 28 http://conceptclues.blogspot.com/