CARDIOLOGY
ND
MODULE-2 YEAR
JOHN N. HAMATY D.O.
PROGRAM DIRECTOR
INTRODUCTION
COURSE OUTLINE
 OBJECTIVES
 LECTURE MATERIAL
 FINAL EXAM

INTRODUCTION
John Hamaty, D.O. FACC, FACOI
CONTACT INFORMATION:
63 Kresson Road
Cherry Hill, New Jersey
TEL: (856) 755-1173
EMAIL: cardiologyfellowship@sjhg.org
CARDIAC EXAM
INSPECTION OF THE CHEST
FIRST PART OF ANY PHYSICAL
 STANDING, SITTING AND LYING
 CHEST MORPHOLOGY
 CARDIOVASCULAR PULSATIONS-APEX

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.

CARDIAC AUSCULTATION
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
STETHOSCOPE
THE MOST EFFECTIVE STETHOSCOPES
ARE MADE OF PLASTIC TUBING 10-12
INCHES LONG WITH INTERNAL
DIAMETER OF 1/8 IN.
 BELL AND DIAPHRAGM TO COLLECT
SOUND.

STETHOSCOPE
HIGH-FREQUENCY SOUNDS-S1 AND
S2, SYSTOLIC CLICKS AND HIGHPITCHED 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.

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.
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.

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.

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

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
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