00:01
Alright, so now let's review
some of the material
that we've covered.
00:04
In this table, we're going to review
just a few key points in each column
starting with
acute coronary syndrome.
00:10
The most important feature
and the physical exam
for acute coronary syndrome is
does the patient
look distressed?
Is there evidence of
diaphoresis? anxiety?
Is the patient clutching their chest
and certainly are they dyspneic?
When you're thinking about
patients with heart failure,
your going to be looking for
labored breathing,
you're looking for that
third heart sound.
00:27
And then we're using those
other ancillary findings
like increased
jugular vein distension,
whether it's the external
or internal jugular vein,
peripheral edema
and the presence of crackles,
particularly so called
wet or coarse crackles,
Pericarditis, you expect the patient
may be leaning forward
to take some of the tension off
of the pericardial sac.
00:47
And you're going to be
listening for that friction rub
right over the
apex of the heart.
00:52
And then of course, if you think
that person has pericarditis
you also want to evaluate
for cardiac tamponade,
which can be an emergency.
00:59
So you're going to be using
your skills at pulsus paradoxus,
to determine whether or not
there is an increased gap
between inspiration
and respiration.
01:08
Alright, so let's take
a look at this question.
01:10
Which murmur is accentuated
by the valsalva maneuver?
Well, mitral regurgitation,
if we use the valsalva maneuver,
we're going to be
decreasing venous return
less blood means a
quieter murmur of mitral regurge.
01:26
So that's not the right answer.
01:27
The murmur of
hypertrophic cardiomyopathy,
that is definitely going to be
our right answer.
01:32
As we talked about
when the left ventricular walls
come closer together.
01:36
That sound that's
caused by turbulent flow
past the subaortic valve stenosis
is going to become louder.
01:44
Aortic stenosis should
become decreased in loudness,
as would tricuspid regurgitation.
01:49
Which factors would not help
when listening for an S4 gallop?
Have the patient Valsalva,
use the bell,
left lateral decubitus position,
or listening at the apex.
02:05
The best way to listen for
a fourth heart sound
or a third heart sound
is using the belt because it's
going to detect lower pitches.
02:12
The left lateral decubitus position
will help to bring the heart
closer to the chest
and you want to listen at the apex
because that's where you're best
going to hear the sound of blood
hitting against
the stiff left ventricular wall
during the left atrial kick.
02:29
So the answer is having the patient
Valsalva would not help.