Differential Diagnosis Flashcards
Define Bisferiens pulse
2 palpable beats during systole; Hypertrophic Cardiomyopathy
Best felt in the carotid
Define Pulsus Alternans
Alternating strong and weak pulses by >20 mmHg.
LV dysfunction; Best felt radial or femoral
Pulses Paradoxus
Abnormal increase in systolic BP >10mmHg;
Cardiac tamponade
Bigeminal Pulse
Regular coupling of two beats.
Ventricular bigeminy
Discuss the first heart sound
- Best heard over mitral/tricuspid region.
2. Identifies onset of systole
What can cause a split first heart sound?
RBBB
Discuss the second heart sound
Best heard along the upper and middle left sternal border.
Discuss the physiologic splitting of the second heart sound
- Delay of pulmonic valve closure.
- On inspiration, venous return is augmented, delaying closure.
- Close together on expiration
Discuss persistent splitting of S2
Both components audible during inhalation and exhalation.
Discuss Fixed Splitting of S2
Interval between A2 and P2 is wide and unchanged during respiratory cycle.
Atrial Septal Defect and Right ventricular failure
Discuss paradoxical splitting of S2
Pulmonic valve closes before aortic valve; LBBB and aortic stenosis
Discuss S3
Caused by blood from the left atrium slamming into an overfilled ventricle during filling
Where can you best hear S3?
Pt is in left lateral decubitus position.
Discuss the S4 sound
Blood trying to enter a stiff left ventricle during atrial contraction
Discuss opening snap
Due to Calcified valve; AV valve opening
Discuss friction rubs
Caused by inflammation of visceral and parietal pericardium; Heard when pt leans forward
How can you tell a murmur is pathologic?
- Loud
2. Diastolic
Murmur grading scale
1/6: Heard w/ careful listening
2/6: Audible as soon as stethoscope is applied to the chest.
3/6: Louder than previous
4/6: As loud as previous but w/ thrill
5/6: Audible when only edge of scope on chest
6/6: Audible to naked ear
Discuss the properties of Aortic Stenosis murmur
- Radiates to carotids
2. Later the peak, worse the stenosis
Discuss Pulmonic Stenosis murmur
Radiates to left side of neck, usually with thrill
Discuss mitral regurgitation murmur
radiates to axila, best heard in left lateral decubitus position
Discuss patent ductus arteriosus
Machine like murmur; left to right shunting
