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Questions and Answers
What is the correct relationship between S3 and S4 heart sounds regarding their pathological significance?
What is the correct relationship between S3 and S4 heart sounds regarding their pathological significance?
Which of the following signs is associated specifically with left-sided heart failure?
Which of the following signs is associated specifically with left-sided heart failure?
Where can the mitral valve sound be best auscultated?
Where can the mitral valve sound be best auscultated?
Which physical examination finding would likely indicate carotid artery stenosis?
Which physical examination finding would likely indicate carotid artery stenosis?
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What does orthopnea refer to in clinical terms?
What does orthopnea refer to in clinical terms?
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Study Notes
Heart Sounds and Murmurs
- S1: Closure of tricuspid and mitral valves (lub), start of systole
- S2: Closure of pulmonic and aortic valves (dub), end of systole
- Aortic Valve: Located at the right 2nd intercostal space or cardiac apex
- Pulmonic Valve: Located at the left 2nd and 3rd intercostal spaces
- Tricuspid Valve: Located at or near the lower left sternal border
- Mitral Valve: Located at and around the cardiac apex
- Orthopnea: Shortness of breath while supine
- Paroxysmal Nocturnal Dyspnea (PND): Waking up from shortness of breath and opening a window to breathe
- S3: Volume overload; not always pathological (e.g., pregnancy)
- S4: Stiffness of the ventricles; always pathologic
Heart Murmurs
- Diaphragm: Used for S1 and S2 and aortic and mitral regurgitation and pericardial friction rubs
- Bell: Used for S3 and S4 and to find murmurs of mitral stenosis
- Right sided Heart Failure (HF): jugular venous distension (neck bulging), hepatomegaly, peripheral edema, pulmonary hypertension
- Left sided HF: lightheaded, pallor, sweating, hair loss, weak pulses, and pulmonary edema
Pulsations
- Carotid pulsations: Height of pulsations unchanged by position and not affected by inspiration
- Internal Jugular pulsations: Height of pulsations changes with position, rarely palpable, height falls with inspiration
Other Relevant Information
- Venous thromboembolism (VTE): includes Deep Vein Thrombosis (DVT) and pulmonary embolism (PE)
- Aortic dissection: Ripping chest pain and widened mediastinum, an urgent condition.
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