S4 double differential - GrepMed

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Double Apical Impulse (S4) Visualization on Physical Exam - Hi-Res Video Version: https://www.grepmed.com/images/7802/physicalexam-cardiology-impulse-double-gallop-apical-signs

On palpation, the PMI

Double Apical Impulse ... (S4) Visualization ... A prominent S4 sound ... The S4 sound is ... #Impulse #S4 #Gallop

Double Apical Impulse (S4) Visualization on Physical Exam - A small stick taped to the chest

Double Apical Impulse ... (S4) Visualization ... had a prominent S4 ... #Double #Apical ... #Impulse #S4 #Gallop

Cardiac Auscultation Practice - S4 Gallop

S4: add this extra heart sounds by tapping first finger twice

Setup:

Auscultation Practice - S4 ... Gallop S4: add

Apical Impulse Waveforms on Physical Examination
- Normal
- Sustained Palpable S4
- "Triple Ripple"
- Palpable S3

#Apical #Impulse #Waveforms

Sustained Palpable S4

Myocarditis
Diagnosis
• Endomyocardial biopsy (gold standard, rarely performed)
• Clinical presentation
• Cardiovascular MRI
Clinical
•

tachycardia • S3, S4

$Double Counting on Cardiac Monitoring The “double counting” heart rate phenomenon. T waves are so prominent the$

Double Counting ... Monitoring The “double ... @EM_RESUS #Double

Kidney Biopsy - Diagnosis Algorithms
1) Normal Glomerulus by LM
2) Glomerular Crescents
3) Double Contours of GBM
4) Endocapillary

Crescents 3) Double

Restrictive Cardiomyopathy - Diagnosis and Causes
Clinical: Dyspnea, Exercise Intolerance, ↑ "Right Sided-Symptoms" (ascites, hepatomegaly, ↑↑peripheral edema)
Physical

Descents, Rales,+S4 ... Diagnosis #Causes #differential

Spinal Cord Injury by Nerve Root Levels
Spinal Root Sensory Motor Reflex
C4 Acromioclavicular Joint Respiration None
C5 Radial Antecubital Fossa Elbow Flexion Biceps Reflex
C6 Dorsal Thumb Wrist Extension Brachioradialis Reflex
C7 Dorsal

Bulbocavernosus S3/S4 ... NerveRoots #Levels #differential

Pulmonary Renal Syndromes and Mimics - Differential Diagnosis Framework
Diffuse alveolar hemorrhage + rapidly progressive glomerulonephritis
90%:
-

Syndromes and Mimics - Differential ... Anti-GBM Disease - Double ... Syndromes #Mimics #Differential

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