1. CARDIOLOGY MODULE-2ND YEAR
JOHN N. HAMATY D.O.
PROGRAM DIRECTOR

2. INTRODUCTION
COURSE OUTLINE
OBJECTIVES
LECTURE MATERIAL
FINAL EXAM

3. John Hamaty, D.O. FACC, FACOI
INTRODUCTION
John Hamaty, D.O. FACC, FACOI
CONTACT INFORMATION:
Noelle Folkman
1 Brace Road, Suite C
Cherry Hill, New Jersey
TEL: (856)

4. CARDIAC EXAM

5. INSPECTION OF THE CHEST
FIRST PART OF ANY PHYSICAL
STANDING, SITTING AND LYING
CHEST MORPHOLOGY
CARDIOVASCULAR PULSATIONS-APEX

8. PALPATION RIGHT SIDE OF SUPINE PATIENT USE FINGERTIPS
TIME USING SIMULTANEOUS PALPATION OF THE CAROTID PULSE
CHEST EXPOSED AND 30 DEGREES WITH PATIENT LATERAL DECUB.

10. CARDIAC AUSCULTATION

11. GENERAL PRINCIPLES
VIBRATIONS ON THE SURFACE OF CHEST SET INTO MOTION A COLUMN OF AIR THAT IS COLLECTED AND CONDUCTED TO THE EAR BY THE STETHOSCOPE

12. STETHOSCOPE
THE MOST EFFECTIVE STETHOSCOPES ARE MADE OF PLASTIC TUBING INCHES LONG WITH INTERNAL DIAMETER OF 1/8 IN.
BELL AND DIAPHRAGM TO COLLECT SOUND.

14. STETHOSCOPE
HIGH-FREQUENCY SOUNDS-S1 AND S2, SYSTOLIC CLICKS AND HIGH-PITCHED MURMURS ARE HEARD BEST WITH THE DIAPHRAGM.
THE BELL IS APPLIED LIGHTLY TO CHEST TO PREVENT AMBIENT NOISE
BELL IS FOR LOW FREQUENCY-3RD AND 4TH SOUNDS, DIASTOLIC MURMURS.

17. HEART SOUNDS FIRST HEART SOUND:
Occurs before palpable arterial upstroke of the carotid and can be distinguished from S2, which occurs immediately after peak of carotid pulse
Heard best medial to apex at lower left sternal border.

18. FIRST HEART SOUND TWO COMPONENTS
INITIAL COMPONENT IS THE MOST PROMINENT AT THE APEX. THIS REPRESENTS MITRAL VALVE CLOSURE.
SECOND PORTION OF S1 IS CLOSURE OF TRICUSPID VALVE AND HEARD BEST AT 4TH LEFT INTERCOSTAL SPACE.

20. FIRST HEART SOUND
OPENING OF THE AORTIC AND PULMONIC VALVES ALSO OCCURS DURING S1 BUT IS USUALLY SILENT.
USUALLY A SINGLE SOUND. IT CAN BE SPLIT, ACCUNTUATED OR PARADOXICALLY SPLIT IN CERTAIN DISEASE STATES.

21. THE SECOND HEART SOUND THE FIRST COMPONENT AORTIC VALVE CLOSURE
THE SECOND COMPONENT IS PULMONIC VALVE CLOSURE
INSPIRATORY SPLITTING OF S2 IS DUE TO DELAY IN PULMONIC COMPONENT

22. THIRD HEART SOUND
Low frequency diastolic sounds that originate from the ventricles(Rt/Lt)
Occur during rapid filling of ventricle
Occurs as passive ventricular filling begins after actual relaxation is complete
Therefore it occurs just after S2
Heard best with the bell.
Left lateral position

24. FORTH HEART SOUND Occurs after P wave on ecg.
Suggested that the atrial contribution is enhanced to overcome LV filling pressures.
Atrial “Kick” against a noncompliant ventricle
Heard best with bell
Left lateral position