Cardiac Examination and Heart Sounds PDF

- S1: closure of tricuspid and mitral valves (lub); start of systole - S2: closure of pulmonic and aortic valves (dub); end of systole - Aortic valve: right 2^nd^ intercostal space or cardiac apex - Pulmonic valve: left second and 3^rd^ intercostal spaces close to the sternum - Tri...

- S1: closure of tricuspid and mitral valves (lub); start of systole - S2: closure of pulmonic and aortic valves (dub); end of systole - Aortic valve: right 2^nd^ intercostal space or cardiac apex - Pulmonic valve: left second and 3^rd^ intercostal spaces close to the sternum - Tricuspid valve: at or near the lower left sternal border - Mitral valve: at and around the cardiac apex - Orthopnea: shortness of breath while supine - Paroxysmal nocturnal dyspnea: waking up from SOB and opening a window to breath - S3: volume overload status; not always pathologic (pregnancy) - S4: stiffness of the ventricles; always pathologic - Use diaphragm for S1 and S2 and for aortic and mitral regurgitation and pericardial friction rubs - Use bell for S3 and S4 and for murmur of mitral stenosis - Right sided HF: jugular venous distension (neck bulging), hepatomegaly, peripheral edema, pulmonary hypertension - Left sided HF: lightheaded, pallor, sweating, hair loss, weak pulses, pulmonary edema - 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 - Carotid artery stenosis: bruit, can lead to stokes - Venous thromboembolism (VTE): includes DVT, PE - Aortic dissection ripping chest pain and widened mediastinum Urgent!