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Cardiac Auscultation Practice - S4 Gallop

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

Setup:
Auscultation Practice - S4 ... Gallop S4: add ... ptfaddenMD #S3 #Gallop
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
Apical Impulse (S4 ... physicalexam-cardiology-impulse-double-gallop-apical-signs ... A prominent S4 sound ... The S4 sound is ... #Gallop #PhysicalExam
Double Apical Impulse (S4) Visualization on Physical Exam - A small stick taped to the chest
Apical Impulse (S4 ... had a prominent S4 ... Apical #Impulse #S4 ... #Gallop #PhysicalExam
Myocarditis
Diagnosis 
• Endomyocardial biopsy (gold standard, rarely performed) 
• Clinical presentation 
• Cardiovascular MRI 
Clinical 
•
tachycardia • S3, S4 ... or summation gallop
Apical Impulse Waveforms on Physical Examination
- Normal
- Sustained Palpable S4
- "Triple Ripple"
- Palpable S3

#Apical #Impulse #Waveforms
Sustained Palpable S4
Cardiac Auscultation Practice - S3 Gallop

S3: add this extra heart sound by tapping second finger twice

Setup:
Practice - S3 Gallop ... ptfaddenMD #S3 #Gallop
HFrEF - Low Ejection Fraction on Physical Exam - Likelihood Ratios
 - Displaced Apical Impulse
 -
Respirations - S3 Gallop
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
Tetralogy of Fallot 

1. Right ventricular outflow tract obstruction 

2. Right ventricular hypertrophy 

3. Ventricular septal
Tetralogy of Fallot ... #Tetralogy #Fallot