What is Gallop rhythm
3 sounds heard during each cardiac cycle produce triple rhythm
Triple rhythm with sinus tachycardia produce Gallop rhythm imitating the sounds of galloping horse.LV S3 gallop - is an important auscultatory sign of Left ventricular failure.
LVS3 is a sign of systolic dysfunction of ventricle.
Early S3 is heard in RVEMF -this is due to sudden limitation of ventricular filling.
Pericardial knock - An early S3 in constrictive pericarditis as in RV EMF.
S3 gallop is common in:
- Dilated cardiomyopathy.
- Decompensated aortic valve disease.
- Decompensated hypertensive heart disease.
It is heard at LLSB.
Inspiratory augmentation is present.
This is associated with tricuspid regurgitation.
Atrial gallop S1,S2, S4
Ventricular gallop S1, S2, S3
Ventricular gallop S1, S2, S3
Quadruple Rhythm
Quadruple rhythm is the presence of 4 heart sounds
(S1, S2, S3 and S4).
Quadruple rhythm is the presence of 4 heart sounds
(S1, S2, S3 and S4).
Summation Gallop
Summation is the presence of S1,S2 with merged S3 and S4
Summation is the presence of S1,S2 with merged S3 and S4
Causes of Striae over the abdomen
Striae is due to stretching of the abdominal wall that is severe enough to cause rupture of the elastic fibres in the skin and produces pink linear marks with a wrinkled appearance indicates recent change in the size of abdomen.
Striae types:
White striae or striae albicans is seen in
White striae or striae albicans is seen in
- Obese persons who lost weight suddenly
- Following pregnancy
- Relieving ascites
- Recent or past abdominal distension
- Cushing's syndrome
- Prolonged steroid therapy
Types of continuous murmur
Continuous murmur with cyanosis
- TOF with PDA
- Pulmonary atresia with bronchopulmonary anastomoses
- Pulmonary AVF
- PDA
- Peripheral Pulmonaryartery stenosis
- Broncho pulmonary anastomoses
- Rupture of sinus of Vakalva (RSOV)
- Coronary arteriovenous fistula
- Anomalous origin of left coronary artery from pulmonary artery (ALCAPA)
- Pulmonary arteriovenous fistula
Inspection for shape and movement of the chest
Looking from above (standing behind the patient), over the shoulders or the upper part of the chest.If standing or sitting is not possible for the patient, inspect the chest in Iying down position, patient lies absolutely straight in the bed in supine position) inspect from the
- Top.
- Foot end of the bed.
- The sides in profile.
- Head end.
- Back (try to turn the patient to any one side).
The following are the points to note :
- Any deformity, fullness or depression (i.e. shape of the chest), apical impulse etc.
- Back (winging of the scapula, drooping of the shoulder, kyphoscoliosis, gibbus. skin changes).
- Whether both the sides of the chest arc moving simultaneously and symmetrically.
- Classically winged scapula is found in paralysis of nerve to serratus anterior (C 6 ,7) and sometimes in facio-scapulo-humeral muscular dystrophy.
- Assessment of the expansion of the upper lobes is better achieved by inspection
- From behind the patient, looking down at the clavicles during moderate respiration.
- Equal on both sides - normal
- Reduced movement on one side - pleural disease ,pulmonary disease
- Bilaterally reduced movement - in emphysema.
History taking in cardiovascular disorders
Presenting symptoms in chronological order include
- Dyspnoea
- Palpitation
- Chest pain
- Cyanosis
- Edema
- Syncopal attack
- Cough and hemoptysis
- Fatigue.
- Detailing of each symptom
- Enquire about the presence of Diabetes mellitus, Dyslipidemia Hypertension etc.
- Rheumatic fever
- Sexually transmitted diseases
- Other illness.
- Hypertension
- CAD
- Diabetes mellitus
- Obesity
- Rheumatic and congenital heart disease
- Dyslipidemia.
- Alcoholism
- Smoking
- Occupation
- Exercise
- Diet
- Drugs fo - CAD.hypertension,
- Diabetes mellitus dyslipidemia.
Causes of fourth heartsound
LV S4 causes
- Systemic hypertension
- AS (left ventricular hypertrophy)
- LV myocardial infarction
- Pulmonary hypertension
- Pulmonary stenosis (Right Ventricular hypertrophy)
- RV myocardial infarction.
- Heard at LLSB
- Inspiratory augmentation present
- Associated with a wave in JVP
- Seen in PAH and pulmonary stenosis
S1+S2+S3/S4
Quadruple rhythm
S1,S2 + S3 + S4.
Seen In:
- Cardiomyopathy
- Coronary artery disease
S, S3 with merged S, & S4.
Causes of pathological S4
- Hypertrophic cardiomyopathy
- Systemic hypertension
- Coronary artery disease
- Myocardial infarction
- Ventricular aneurysm.
S4 -Atrial contraction sound.
Achronym
LV : Left Ventricular
AS : Aortic Stenosis
RV : Right Ventricular
S1 - First Heart Sound
S2 - Second Heart Sound
S3 - Third Heart Sound
S4 - Fourth Heart Sound
Assessment of position of Trachea
Trail's sign
Shift of trachea produces prominence of sternal head of sternocleidomastoid on the side to which the trachea is shifted. It is called Trail's sign.The pretracheal fascia encloses the clavicular head of stemomastoids muscle on both sides. When the trachea is shifted to one side, the pretracheal fascia covering the stemomastoid muscle on that side relaxes, producing the clavicular head more prominent on the side of tracheal deviation.
Causes of tracheal shift
Pleural disease - Shift to opposite side
- Pleural effusion
- Pneumothorax
- Fibrosis and collapse of lung
Position of the Trachea and Trail's sign
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