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wikademia>Captain Sockpuppet |
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| ==Inspection==
| | DADADADADAAAAAAA CAPTAIN VANDAL STRIKES AGAIN!!!!!!!!!!!!!!!!!!!!! |
| *from the foot of the bed
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| **chest wall deformity (pectus excavatum, carinatum)
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| **scars (thoracotomy, pacemaker)
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| **heaves (ventricular hypertrophy) and lifts
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| **visible apical beat
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| **impulses (under xiphoid – can mean RVH or Aorta).
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| ==Palpation==
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| *using finger pads, palpate for apex impulse (PMI) - ''accurately measure MCL''
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| **location, size - one ICS
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| **amplitude - if increased, suggests volume/pressure overload
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| **duration - check in relation to carotid pulse (> 2/3 systole → sustained, LVH)
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| **if carotid is delayed = '''parvus et tardus''' → AV stenosis
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| *thrills - palpate at each of the 4 valve zones = grade 4 murmur
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| *heaves (with heel of hand)
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| **left sternal border → LVH
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| **PV → pulmonary hypertension
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| **AV → systemic hypertension
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| **inferior to xiphoid - RVH
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| ==Auscultation==
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| *listen specifically for one sound at a time
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| *calibrate your timing to the radial pulse
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| *S1 > S2 in LLSB
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| *S2 > S1 in LUSB
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| ===S1===
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| *louder → ↓ PR interval, ↑CO, ↑HR
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| *quieter → ↑ PR interval, MR, severe MS
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| *splitting → RBBB
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| ===S2===
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| *splitting ↑ by continued inspiration (while patient not holding in breath)
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| *Loud S2 → hypertension (systemic or pulmonary circulation)
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| *Wide split S2 - RBBB, Pulmonary stenosis
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| *Fixed split S2 - ASD
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| *Paradoxical: LBBB, severe AS
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| ===S3 (Ventricular Gallop)===
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| *lightly use bell at apex, best heard in LLD
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| *can be normal in young people and the pregnant
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| *noted in volume overload, increased transvalvular flow (TR, MR)
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| ===S4 (Atrial Gallop)===
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| *lower pitched
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| *indicates stiff LV– LVH, post-MI
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| ===Other sounds===
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| * '''Ejection click''' - between S1 and S2
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| * '''Carotid bruit'''
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| * '''Pericardial friction'''
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| ===Murmurs===
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| Describe a murmur in its ''timing'', ''shape'', ''intensity'' and ''radiation''
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| {| border="1" cellpadding="2" cellspacing="0"
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| |-
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| |Type
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| |Character
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| |Best Heard
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| |Radiation
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| |-
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| |Aortic stenosis
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| |systolic, crescendo-decrescendo
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| |AV, lean forward
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| ↓with Valsalva
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| |carotids, clavical
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| |-
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| |Aortic regurg
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| |early diastolic
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| decrescendo
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| |L2-4 ICS
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| Lean foward
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| |Apex
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| |-
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| |Mitrial Stenosis
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| |Mid diastolic rumble
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| |Apex, LLD
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| |No radiation
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| |-
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| |Mitrial Regurge
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| |pansystolic
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| |apex
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| |L axilla
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| |-
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| |VSD
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| |pansystolic, harsh
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| |L sternal border
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| |-
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| |PDA
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| |continuous
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| |aortic valve
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| |L clavical
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| |}
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| ====Intensity====
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| 1/6 = quieter than S1<br>
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| 2/6 = same as S1<br>
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| 3/6 = louder than S1 with no thrill<br>
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| 4/6 = thrill present<br>
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| 5/6 = heard with edge of scope in contact with skin<br>
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| 6/6 = heard with scope off of the chest<br>
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| ==Special tests==
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| *↑ blood flow to heart (leg raise, squatting)
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| **↑ AS, ↓HoCM, ↓MR
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| *↓ blood flow to heart (Valsalva)
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| **↓ AS, ↑ MR, ↑HoCM
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| ==Other OSCE modules==
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| {{OSCE2}}
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| [[Category:Medicine]][[Category:OSCE]]
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DADADADADAAAAAAA CAPTAIN VANDAL STRIKES AGAIN!!!!!!!!!!!!!!!!!!!!!
