Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Chronological localisation during cardiac auscultation

196 views

Published on

Many cardiologists are not able to perform effective cardiac auscultation and helpless without ultrasound. Sad but true. But some simple skills can significantly improve the situation. In the nearest future, I hope to publish my book which will simplify the development of these skills, one of which I called 'chronological localisation'. This skill is vital. Heart auscultation just does not exist without it.
Fortunately, you need to memorise very little logical information. Later, practice these skill. More in the slideshow.
This is a part of my book which will appear soon.

Watch the slideshow about chronological localisation in cardiac auscultation

cardiacauscultation.com

Published in: Health & Medicine
  • Be the first to comment

Chronological localisation during cardiac auscultation

  1. 1. Chronological Localization During Heart Auscultation Yaroslav Shpak, M.D., cardiacauscultation.com
  2. 2. You may not know something or just scratch a surface of available information
  3. 3. Nevertheless, you still might be able to solve your problem effectively. This is acceptable…
  4. 4. But there are some key skills in every field, without which…
  5. 5. NOTHING AT ALL can be done.
  6. 6. This topic is exactly that case
  7. 7. What are we talking about?
  8. 8. In the sound stream we perceive during heart auscultation, we have to: • separate each element • locate each element in coordinates of the cardiac cycle
  9. 9. All “heart music” consists of two elements: • Heart sounds. Short, beat-like or click-like. • Heart murmurs. Prolonged in time.
  10. 10. The difference is in a continuance: moment/d u r a t i o n
  11. 11. While listening to an abstract and disorganized sound of the heart…
  12. 12. it is necessary to split it into its constituent basic elements and precisely place each element in relation to the phases of cardiac cycle.
  13. 13. Cardiac cycle repeats over time. Let’s depict time on a horizontal line. Time goes from left to right. Like this:
  14. 14. There are two phases in cardiac cycle: • Systole • Diastole
  15. 15. During systole, ventricles eject blood.
  16. 16. During diastole, ventricles are filled with blood.
  17. 17. How to distinguish between systole and diastole?
  18. 18. There are two principal marks which clearly distinguish systole anddiastole.
  19. 19. They are the first heart sound (S1) and the second heart sound (S2)
  20. 20. S1 is formed by closing of the atrioventricular valves (mitral and tricuspide)
  21. 21. S2 is formed by closing of the semilunar valves (aortic and pulmonic)
  22. 22. No matter who is examined, S1 and S2 are heard almost always
  23. 23. The period between T1 and T2 is systole
  24. 24. The period between S2 and S1 is diastole
  25. 25. It remains only to distinguish between T1 and T2
  26. 26. These four rules will help you: • S1 and S2 sound differently • S1 and S2 have specific areas, where they are extra loud • S1-S2 period is usually shorter than S2-S1 period • The peak of the carotid pulse wave falls on S1-S2 period
  27. 27. S1 and S2 sound differently
  28. 28. S1: • Lower pitch, contains less high-frequency oscillations • Lasts longer
  29. 29. S2: • Clearer, clicking, contains more high-frequency oscillations • Shorter in duration
  30. 30. S1 and S2 have specific areas, where they are extra loud
  31. 31. S2 is almost always louder at the base of the heart
  32. 32. Having caught S2 at the heart base and fixed our attention on it, we can slowly move a chest piece of our stethoscope toward the tricuspid and mitral areas. By fixing our attention on S2, we can correlate S2 in relation to other auscultatory symptoms.
  33. 33. S1 is often louder at the apex of the heart. But not always.
  34. 34. S1-S2 period is usually shorter than S2-S1 period
  35. 35. This rule doesn’t work with tachycardia
  36. 36. The peak of carotid pulse wave falls on S1-S2 period
  37. 37. If, while auscultating, we start palpating pulse on the common carotid arteries, we will find out that...
  38. 38. The peak of common carotid pulse wave falls on S1-S2 period
  39. 39. Let’s repeat these four rules: • S1 and S2 sound differently • S1 and S2 have specific areas, where they are extra loud • S1-S2 period is usually shorter than S2-S1 period • The peak of the carotid pulse wave falls on S1-S2 period
  40. 40. After we separated all elements of the heart sound,
  41. 41. … we should define each element’s position within the cardiac cycle.
  42. 42. However, it is not enough to say that something registers in systole or diastole.
  43. 43. It is necessary to determine the exact position
  44. 44. Usually, it is enough to point out if auscultatory symptom registers at the beginning, middle or the end of systole or diastole.
  45. 45. For instance, this sound is early systolic:
  46. 46. And this murmur is late diastolic:
  47. 47. If the murmur continues throughout the entire systole, it is called pansystolic.
  48. 48. That’s all. Quite simple, isn’t it?

×