on auscultation the heart sound s1 indicates the closure of the
atrioventricular valves
1795535
by the closing of the atrioventricular valves and semilunar valves, respectively. In addition to these normal sounds, a variety of other sounds may be present including heart murmurs, adventitious sounds, and gallop rhythms S and S. Heart murmurs are generated by turbulent flow of blood and a murmur to be heard as turbulent flow must require pressure difference of at least 30 mm of hg between the chambers and the pressure dominant chamber will out flow the blood to non dominant chamber in diseased condition which leads to Left-to-right shunt or Right-to-left shunt based on the pressure dominance. Turbulence may
Heart sounds
14451088
ventricles, pushing open the tricuspid and mitral valves. As pressure drops within the ventricles, blood flows from the major veins into the relaxed atria and from there into the ventricles. Both chambers are in diastole, the atrioventricular valves are open, and the semilunar valves remain closed. The cardiac cycle is complete. One of the simplest methods of assessing the heart's condition is to listen to it using a stethoscope. In a healthy heart, there are only two audible heart sounds, called S1 and S2. The first heart sound S1, is the sound created by the closing of the atrioventricular valves
Cardiac physiology
473106
of the atrioventricular valves during ventricular contraction and is normally described as "lub". The second heart sound, S2, is the sound of the semilunar valves closing during ventricular diastole and is described as "dub". Each sound consists of two components, reflecting the slight difference in time as the two valves close. S2 may split into two distinct sounds, either as a result of inspiration or different valvular or cardiac problems. Additional heart sounds may also be present and these give rise to gallop rhythms. A third heart sound, S3 usually indicates an increase in ventricular blood volume. A fourth heart
Heart
1795537
heart sound, or S, forms the "lub" of "lub-dub" and is composed of components M (mitral valve closure) and T (tricuspid valve closure). Normally M precedes T slightly. It is caused by the closure of the atrioventricular valves, i.e. tricuspid and mitral (bicuspid), at the beginning of ventricular contraction, or systole. When the ventricles begin to contract, so do the papillary muscles in each ventricle. The papillary muscles are attached to the cusps or leaflets of the tricuspid and mitral valves via chordae tendineae (heart strings). When the papillary muscles contract, the chordae tendineae become tense and thereby prevent the
Heart sounds
1783507
from prolapsing into the atria when they close. The subvalvular apparatus has no effect on the opening and closure of the valves, however, which is caused entirely by the pressure gradient across the valve. The peculiar insertion of chords on the leaflet free margin, however, provides systolic stress sharing between chords according to their different thickness. The closure of the AV valves is heard as lub, the first heart sound (S1). The closure of the SL valves is heard as dub, the second heart sound (S2). The mitral valve is also called the bicuspid valve because it contains two leaflets
Heart valve
1795539
the ventricles against closed semilunar valves, sends blood rushing back toward the atria, and the parachute-like valves catch the rush of blood in their leaflets causing the valve to snap shut. The S1 sound results from reverberation within the blood associated with the sudden block of flow reversal by the valves. The delay of T1 even more than normally causes the split S1 which is heard in a right bundle branch blockage. The second heart sound, or S, forms the "dub" of "lub-dub" and is composed of components A (aortic valve closure) and P (pulmonary valve closure). Normally A precedes
Heart sounds
1795542
protodiastolic gallop, ventricular gallop, or informally the "Kentucky" gallop as an onomatopoeic reference to the rhythm and stress of S1 followed by S2 and S3 together (S1=Ken; S2=tuck; S3=y). "lub-dub-ta" or "slosh-ing-in" If new, indicates heart failure or volume overload. It occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin. The third heart sound is benign in youth, some trained athletes, and sometimes in pregnancy but if it re-emerges later in life it may signal cardiac problems, such as a failing left ventricle as in
Heart sounds
15688118
Computer-aided auscultation aimed at detecting and characterizing heart murmurs is called computer-aided heart auscultation (also known as automatic heart sound analysis). Auscultation of the heart using a stethoscope is the standard examination method worldwide to screen for heart defects by identifying murmurs. It requires that an examining physician have acute hearing and extensive experience. An accurate diagnosis remains challenging for various reasons including noise, high heart rates, and the ability to distinguish innocent from pathological murmurs. Properly performed, the auscultatory examination of the heart is commonly regarded as an inexpensive, widely available tool in the detection and management of heart
Computer-aided auscultation
3122811
in severe aortic regurgitation, based on the 2012 American College of Cardiology/American Heart Association guidelines include: Chest X-ray can assist in making the diagnosis, showing left ventricular hypertrophy and dilated aorta. ECG typically indicates left ventricular hypertrophy. Cardiac chamber catheterization assists in assessing the severity of regurgitation and any left ventricular dysfunction. The physical examination of an individual with aortic insufficiency involves auscultation of the heart to listen for the murmur of aortic insufficiency and the S3 heart sound (S3 gallop correlates with development of LV dysfunction). The murmur of chronic aortic insufficiency is typically described as early diastolic and
Aortic insufficiency
12894352
Split S2 A split S2 is a finding upon auscultation of the S2 heart sound. It is caused when the closure of the aortic valve (A) and the closure of the pulmonary valve (P) are not synchronized during inspiration. In a healthy person, A is followed by P. During inspiration, the chest wall expands and causes the intrathoracic pressure to become more negative (think of a vacuum). The increased negative pressure allows the lungs to fill with air and expand. While doing so, it also induces an increase in venous blood return from the body into the right atrium via
Split S2
15688121
problems but may also be caused by a wide array of structural heart defects. Various characteristics constitute a qualitative description of heart murmurs, including timing (systolic murmur and diastolic murmur), shape, location, radiation, intensity, pitch and quality. CAA systems typically categorize heart sounds and murmurs as Class I and Class III according to the American Heart Association: More sophisticated CAA systems provide additional descriptive murmur information like murmur timing, grading, or the ability to identify the positions of the S1/S2 heart sounds. The detection of heart murmurs in CAA systems is based on the analysis of digitally recorded heart sounds.
Computer-aided auscultation
1795552
of flow reversal by the valves closing. Because of this, auscultation to determine function of a valve is usually not performed at the position of the valve, but at the position to where the sound waves reverberate. Using electronic stethoscopes, it is possible to record heart sounds via direct output to an external recording device, such as a laptop or MP3 recorder. The same connection can be used to listen to the previously recorded auscultation through the stethoscope headphones, allowing for more detailed study of murmurs and other heart sounds, for general research as well as evaluation of a particular
Heart sounds
12092878
Souffle (heart sound) A souffle () is a vascular or cardiac murmur with a blowing quality when heard on auscultation. It is particularly used to describe vascular murmurs or transmitter heart sounds which occur during pregnancy, either from the uterus and breasts of the mother, or from the fetus. Uterine souffle or placental souffle is a soft, blowing sound heard using a stethoscope, usually in the second trimester of pregnancy (13–28 weeks). This sound is heard most clearly in the lower part of the uterus and is synchronous with the pulse of the mother. The uterine souffle is produced by
Souffle (heart sound)
12092875
Souffle (heart sound) A souffle () is a vascular or cardiac murmur with a blowing quality when heard on auscultation. It is particularly used to describe vascular murmurs or transmitter heart sounds which occur during pregnancy, either from the uterus and breasts of the mother, or from the fetus. Uterine souffle or placental souffle is a soft, blowing sound heard using a stethoscope, usually in the second trimester of pregnancy (13–28 weeks). This sound is heard most clearly in the lower part of the uterus and is synchronous with the pulse of the mother. The uterine souffle is produced by
Souffle (heart sound)
1795574
severe form known as caseous calcification of the mitral valve that can be mistaken for intracardiac mass or thrombus. The closing of the mitral valve and the tricuspid valve constitutes the first heart sound (S1), which can be heard with a stethoscope. It is not the valve closure itself which produces the sound but the sudden cessation of blood flow, when the mitral and tricuspid valves close.. Abnormalities associated with the mitral valve can often be heard when listening with a stethoscope. The mitral valve is often also investigated using an ultrasound scan, which can reveal the size and flow
Mitral valve
1795553
patient's condition. Heart sounds Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the heart valves snap shut. In cardiac auscultation, an examiner may use a stethoscope to listen for these unique and distinct sounds that provide important auditory data regarding the condition of the heart. In healthy adults, there are two normal heart sounds, often described as a "lub" and a "dub" (or "dup"), that occur in sequence with each heartbeat. These are the first heart sound (S) and second heart sound
Heart sounds
1795534
Heart sounds Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. Specifically, the sounds reflect the turbulence created when the heart valves snap shut. In cardiac auscultation, an examiner may use a stethoscope to listen for these unique and distinct sounds that provide important auditory data regarding the condition of the heart. In healthy adults, there are two normal heart sounds, often described as a "lub" and a "dub" (or "dup"), that occur in sequence with each heartbeat. These are the first heart sound (S) and second heart sound (S), produced
Heart sounds
8204971
Gallop rhythm A gallop rhythm refers to a (usually abnormal) rhythm of the heart on auscultation. It includes three or four sounds, thus resembling the sounds of a gallop. The normal heart rhythm contains two audible heart sounds called S and S that give the well-known "lub-dub" rhythm; they are caused by the closing of valves in the heart. A gallop rhythm contains another sound, called S or S, dependent upon where in the cycle this added sound comes. It can also contain both of these sounds forming a quadruple gallop, and in situations of very fast heart rate can
Gallop rhythm
12092876
the rush of blood through the dilated vessels of the uterus. On auscultation, uterine souffle may often be confused with funic souffle, which is a sharp, whistling sound that is synchronous with the pulse of the foetus. Therefore, the maternal pulse must be palpated simultaneously in order to confirm uterine souffle. Uterine souffle is considered as a probable objective sign of pregnancy. Funic souffle (also known as funicular or fetal souffle), is a blowing sound heard in synch with fetal heart sounds, and may originate from the umbilical cord. It has also been described as a sharp, whistling sound that
Souffle (heart sound)
14974867
pressure may be elevated or decreased, and the pulse can become irregular. If heart failure ensues, elevated jugular venous pressure and hepatojugular reflux, or swelling of the legs due to peripheral edema may be found on inspection. Rarely, a cardiac bulge with a pace different from the pulse rhythm can be felt on precordial examination. Various abnormalities can be found on auscultation, such as a third and fourth heart sound, systolic murmurs, paradoxical splitting of the second heart sound, a pericardial friction rub and rales over the lung. The primary purpose of the electrocardiogram is to detect ischemia or acute
Myocardial infarction diagnosis
1596488
et tardus". There may also be a noticeable delay between the first heart sound (on auscultation) and the corresponding pulse in the carotid artery (so-called 'apical-carotid delay'). In a similar manner, there may be a delay between the appearance of each pulse in the brachial artery (in the arm) and the radial artery (in the wrist). The first heart sound may be followed by a sharp ejection sound ("ejection click") best heard at the lower left sternal border and the apex, and, thus, appear to be "split". The ejection sound, caused by the impact of left ventricular outflow against the
Aortic stenosis
473105
A person's pulse is taken, usually at the radial artery near the wrist, in order to assess for the rhythm and strength of the pulse. The blood pressure is taken, using either a manual or automatic sphygmomanometer or using a more invasive measurement from within the artery. Any elevation of the jugular venous pulse is noted. A person's chest is felt for any transmitted vibrations from the heart, and then listened to with a stethoscope. Typically, healthy hearts have only two audible heart sounds, called S1 and S2. The first heart sound S1, is the sound created by the closing
Heart
8764972
Tricuspid valve stenosis Tricuspid Valve Stenosis is a valvular heart disease that narrows the opening of the heart's tricuspid valve. It is a relatively rare condition that causes stenosis-increased restriction of blood flow through the valve. A mild diastolic murmur can be heard during auscultation caused by the blood flow through the stenotic valve. It is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide-splitting S1. It may increase in intensity with inspiration (Carvallo's sign). The diagnosis will typically be confirmed by an echocardiograph, which will also allow the physician to assess its
Tricuspid valve stenosis
2940181
regurgitations while classic stethoscope auscultation presented a sensitivity of 58%. Moreover, Doppler auscultation was superior in the detection of impaired ventricular relaxation. Since the physics of Doppler auscultation and classic auscultation are different, it has been suggested that both methods could complement each other. Auscultation Auscultation (based on the Latin verb "auscultare" "to listen") is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (heart and breath sounds), as well as the gastrointestinal system (bowel sounds). The term was introduced by René Laennec. The
Auscultation
2091342
the fifth Korotkov sound (i.e. silence) as the diastolic blood pressure, as this has been felt to be more reproducible. For pediatrics auscultation of the fourth Korotkov sound is the guiding indicator of diastolic pressure. The time average of the first Korotkov sound represents a reliable pressure marker of systole of the heart. The time average of the fourth Korotkov sound represents a reliable pressure marker of diastole of the heart. Korotkoff sounds Korotkov sounds are the sounds that medical personnel listen for when they are taking blood pressure using a non-invasive procedure. They are named after Dr. Nikolai Korotkov,
Korotkoff sounds
12357058
after vomiting, then obstruction is a likely etiology. However, vomiting does not relieve the pain brought on by pancreatitis or cholecystitis. It is important to watch out for signs of dehydration, such as orthostatic hypotension and loss of skin turgor. Auscultation of the abdomen can produce several clues to the cause of nausea and vomiting. A high-pitched tinkling sound indicates possible bowel obstruction, while a splashing "succussion" sound is more indicative of gastric outlet obstruction. Eliciting pain on the abdominal exam when pressing on the patient may indicate an inflammatory process. Signs such as papilledema, visual field losses, or focal
Nausea
6187740
Pericardial friction rub A pericardial friction rub, also pericardial rub, is an audible medical sign used in the diagnosis of pericarditis. Upon auscultation, this sign is an extra heart sound of to-and-fro character, typically with three components, ONE systolic and TWO diastolic. It resembles the sound of squeaky leather and often is described as grating, scratching, or rasping. The sound seems very close to the ear and may seem louder than or may even mask the other heart sounds. The sound usually is best heard between the apex and sternum but may be widespread. The pericardium is a double-walled sac
Pericardial friction rub
3107893
class III or IV symptoms. Once an individual develops NYHA class III or IV symptoms, the progression of the disease accelerates and the patient's condition deteriorates. Upon auscultation of an individual with mitral stenosis, the first heart sound is usually loud and may be palpable (tapping apex beat) because of increased force in closing the mitral valve. The first heart sound is made by the mitral and tricuspid heart valves closing. These are normally synchronous, and the sounds are termed M1 and T1, respectively. M1 becomes louder in mitral stenosis. It may be the most prominent sign. If pulmonary hypertension
Mitral valve stenosis
11374437
The Doppler auscultation presented a sensitivity of 84% for the detection of aortic regurgitations, while classic stethoscope auscultation presented a sensitivity of 58%. Moreover, Doppler auscultation was superior in the detection of impaired ventricular relaxation Since the physics of Doppler auscultation and classic auscultation are different, it has been suggested that both methods could complement each other. Doppler fetal monitor A Doppler fetal monitor is a hand-held ultrasound transducer used to detect the fetal heartbeat for prenatal care. It uses the Doppler effect to provide an audible simulation of the heart beat. Some models also display the heart rate in
Doppler fetal monitor
2940178
are still important today.) Laënnec's contributions were refining the procedure, linking sounds with specific pathological changes in the chest, and inventing a suitable instrument (the stethoscope) to mediate between the patient's body and the clinician's ear. Auscultation is a skill that requires substantial clinical experience, a fine stethoscope and good listening skills. Health professionals (doctors, nurses, etc.) listen to three main organs and organ systems during auscultation: the heart, the lungs, and the gastrointestinal system. When auscultating the heart, doctors listen for abnormal sounds, including heart murmurs, gallops, and other extra sounds coinciding with heartbeats. Heart rate is also noted.
Auscultation
2940177
Auscultation Auscultation (based on the Latin verb "auscultare" "to listen") is listening to the internal sounds of the body, usually using a stethoscope. Auscultation is performed for the purposes of examining the circulatory and respiratory systems (heart and breath sounds), as well as the gastrointestinal system (bowel sounds). The term was introduced by René Laennec. The act of listening to body sounds for diagnostic purposes has its origin further back in history, possibly as early as Ancient Egypt. (Auscultation and palpation go together in physical examination and are alike in that both have ancient roots, both require skill, and both
Auscultation
15688125
physician diagnosis, stratified by an echocardiogram-based diagnosis. Published examples include Lai et al. Computer-aided auscultation Computer-aided auscultation or computerized assisted auscultation (CAA) is a digital form of auscultation. It includes the recording, visualization, storage, analysis and sharing of digital recordings of heart or lung sounds. The recordings are obtained using an electronic stethoscope or similarly suitable recording device. Computer-aided auscultation is designed to assist health care professionals who perform auscultation as part of their diagnostic process. Commercial CAA products are usually classified as clinical decision support systems that support medical professionals in making a diagnosis. As such they are medical
Computer-aided auscultation
15688112
Computer-aided auscultation Computer-aided auscultation or computerized assisted auscultation (CAA) is a digital form of auscultation. It includes the recording, visualization, storage, analysis and sharing of digital recordings of heart or lung sounds. The recordings are obtained using an electronic stethoscope or similarly suitable recording device. Computer-aided auscultation is designed to assist health care professionals who perform auscultation as part of their diagnostic process. Commercial CAA products are usually classified as clinical decision support systems that support medical professionals in making a diagnosis. As such they are medical devices and require certification or approval from a competent authority (e.g. FDA approval,
Computer-aided auscultation
3677578
The most common location for attachment of the stalk is the fossa ovalis region of the interatrial septum. An atrial myxoma may create an extra heart sound, audible to auscultation just after S2 It is most seen on echocardiography, as a pedunculated mass that is heterogeneous in appearance. A left atrial myxoma will cause an increase in pulmonary capillary wedge pressure. The differential diagnosis include other cardiac tumors such as lipomas and rhabdomyomas (and rarely teratomas). These other tumors of the heart are typically not pedunculated, however, and are more likely to infiltrate the muscle of the heart. Cardiac magnetic
Myxoma
390198
effect, of the reflected waves. Hence the Doppler stethoscope is particularly suited to deal with moving objects such as a beating heart. It was recently demonstrated that continuous Doppler enables the auscultation of valvular movements and blood flow sounds that are undetected during cardiac examination with a stethoscope in adults. The Doppler auscultation presented a sensitivity of 84% for the detection of aortic regurgitations while classic stethoscope auscultation presented a sensitivity of 58%. Moreover, Doppler auscultation was superior in the detection of impaired ventricular relaxation. Since the physics of Doppler auscultation and classic auscultation are different, it has been suggested
Stethoscope
1795550
inhalation. Inhalation can also produce a non-pathological split S2 which will be heard upon auscultation. With exhalation, the opposite haemodynamic changes occur: left-sided murmurs generally increase in intensity with exhalation. There are a number of interventions that can be performed that alter the intensity and characteristics of abnormal heart sounds. These interventions can differentiate the different heart sounds to more effectively obtain a diagnosis of the cardiac anomaly that causes the heart sound. Clicks – Heart clicks are short, high-pitched sounds that can be appreciated with modern non-invasive imaging techniques. Rubs – The pericardial friction rub can be heard in
Heart sounds
16646314
device detects a heart tone farther away from the location of origin. A Pinard horn must be pressed to a location very close to the fetal heart in order to detect it, providing a more accurate indication of fetal position. A doctor, nurse, or midwife can also use palpation and auscultation to determine fetal position. Pinard horn A Pinard horn is a type of stethoscope used to listen the heart rate of a fetus during pregnancy. It is a hollow horn, often made of wood or metal, about long. It functions similarly to an ear trumpet by amplifying sound. The
Pinard horn
11060867
may have the classic “Beck’s triad” – hypotension, raised JVP and distant heart sounds, when complicated by cardiac tamponade. Extension of the mediastinal air to the subcutaneous tissues via the fascial planes may lead to subcutaneous emphysema. When air and fluid mix together in the pericardial sac, a tinkling sound superimposed over a succussion splash is heard. This is known as a “Bruit de Moulin”, which is French for “Mill–wheel” murmur. Air between the anterior parietal pericardium and the thoracic cage may also give rise to the “Hamman’s Sign” – which is a crunching sound typically heard on auscultation of
Pneumopericardium
9574512
positive and negative studies and yielding a preliminary report. This, for example, can be used for chest pain patients' triage in an emergency setting. Early detection of pathology can be the difference between life and death. CADe can be done by auscultation with a digital stethoscope and specialized software, also known as Computer-aided auscultation. Murmurs, irregular heart sounds, caused by blood flowing through a defective heart, can be detected with high sensitivity and specificity. Computer-aided auscultation is sensitive to external noise and bodily sounds and requires an almost silent environment to function accurately. Chaplot et al. was the first to
Computer-aided diagnosis
12092877
is synchronous with the pulse of the foetus, usually heard during the second trimester of pregnancy (13–28 weeks). It is heard because of the rush of blood through the umbilical arteries of the foetus, and is therefore synchronous with the foetal pulse. The funic souffle is not heard consistently. On auscultation, funic souffle may often be confused with uterine souffle, which is a soft, blowing sound synchronous with the maternal pulse. Therefore, the maternal pulse must be palpated simultaneously in order to differentiate uterine souffle from funic souffle. A mammary souffle is a maternal cardiac murmur heard over the breasts.
Souffle (heart sound)
19809802
specific, physical examination finding. If the casts completely obstruct the airway, breath sounds will be decreased and dullness will be present with percussion. With partial obstruction, a “fan sound” or “flag flapping” sound can be heard during auscultation. Bronchial casts can sometimes fill the airways of almost an entire lung, and present as an acute, life-threatening emergency. The majority of PB cases are associated with an underlying disease. Several systemic illnesses have been associated with plastic bronchitis: The most common form of plastic bronchitis follows cardiac surgery for congenital heart disease, especially the Fontan procedure. Systemic blood flow is diverted
Plastic bronchitis
11374433
Doppler fetal monitor A Doppler fetal monitor is a hand-held ultrasound transducer used to detect the fetal heartbeat for prenatal care. It uses the Doppler effect to provide an audible simulation of the heart beat. Some models also display the heart rate in beats per minute (BPM). Use of this monitor is sometimes known as Doppler auscultation. The Doppler fetal monitor is commonly referred to simply as a "Doppler" or "fetal Doppler". It may be classified as a form of Doppler ultrasonography (although usually not technically -graphy but rather sound-generating). Doppler fetal monitors provide information about the fetus similar to
Doppler fetal monitor
14451132
usually in excess of 110 ms. With restrictive ventricular filling, it is usually under 60 ms. Isovolumic relaxation time Isovolumic relaxation time (IVRT) is an interval in the cardiac cycle, from the aortic component of the second heart sound, that is, closure of the aortic valve, to onset of filling by opening of the mitral valve. It can be used as an indicator of diastolic dysfunction. It can be measured by simultaneous Doppler echocardiography and M-mode sonography, or better still, by simultaneous phonocardiogram and transmitral Doppler. Prolonged IVRT indicates poor myocardial relaxation. A normal IVRT is about 70 ± 12
Isovolumic relaxation time
14451131
Isovolumic relaxation time Isovolumic relaxation time (IVRT) is an interval in the cardiac cycle, from the aortic component of the second heart sound, that is, closure of the aortic valve, to onset of filling by opening of the mitral valve. It can be used as an indicator of diastolic dysfunction. It can be measured by simultaneous Doppler echocardiography and M-mode sonography, or better still, by simultaneous phonocardiogram and transmitral Doppler. Prolonged IVRT indicates poor myocardial relaxation. A normal IVRT is about 70 ± 12 ms, and approximately 10 ms longer in people over forty years. In abnormal relaxation, IVRT is
Isovolumic relaxation time
698032
and in motion. In addition, the science of surface anatomy includes the theories and systems of body proportions and related artistic canons. The study of surface anatomy is the basis for depicting the human body in classical art. Some pseudo-sciences such as physiognomy, phrenology and palmistry rely on surface anatomy. Knowledge of the surface anatomy of the thorax (chest) is particularly important because it is one of the areas most frequently subjected to physical examination, like auscultation and percussion.In cardiology, Erb's point refers to the third intercostal space on the left sternal border where S2 heart sound is best auscultated.
Surface anatomy
6994590
respiratory system problem. It is often recognized on auscultation by a "crunching" sound timed with the cardiac cycle (Hamman's crunch). Pnemomediastinum may also present with symptoms mimicking cardiac tamponade as a result of the increased intrapulmonary pressure on venous flow to the heart. It is most commonly caused by: It has also been associated with: It can be induced to assist thoracoscopic surgery. It can be caused by a pulmonary barotrauma resulting when a person moves to or from a higher pressure environment, such as when a SCUBA diver, a free-diver or an airplane passenger ascends or descends. In rare
Pneumomediastinum
390181
observed that a rolled piece of paper, placed between the patient's chest and his ear, could amplify heart sounds without requiring physical contact. Laennec's device was similar to the common ear trumpet, a historical form of hearing aid; indeed, his invention was almost indistinguishable in structure and function from the trumpet, which was commonly called a "microphone". Laennec called his device the "stethoscope" ("stetho-" + "-scope", "chest scope"), and he called its use "mediate auscultation", because it was auscultation with a tool intermediate between the patient's body and the physician's ear. (Today the word "auscultation" denotes all such listening, mediate
Stethoscope
15688115
cables makes them an ideal sound-capturing device for CAA systems. Devices that can be used to connect to an electronic stethoscope and record the audio signal (e.g. heart or lung sounds) include PC, laptop and mobile devices like smartphones or tablets. Generally, CAA systems include software that can visualize the incoming audio signal. More sophisticated CAA systems include live noise detection algorithms, designed to help the user achieve the best possible recording quality. A key feature of CAA systems is the automated analysis of the recorded audio signals by signal processing algorithms. Such algorithms can run directly on the device
Computer-aided auscultation
15688119
disease. The auscultation skills of physicians, however, have been reported to be declining. This leads to missed disease diagnoses and/or excessive costs for unnecessary and expensive diagnostic testing. A study suggests that more than one third of previously undiagnosed congenital heart defects in newborns are missed by their 6-week examination. More than 60% of referrals to medical specialists for costly echocardiography are due to a misdiagnosis of an innocent murmur. CAA of the heart thus has the potential to become a cost-effective screening and diagnostic tool, provided that its underlying algorithms have been clinical tested in stringent, blinded fashions for
Computer-aided auscultation
2456935
flow first starts again in the artery. The pressure at which this sound began is noted and recorded as the systolic blood pressure. The cuff pressure is further released until the sound can no longer be heard. This is recorded as the diastolic blood pressure. In noisy environments where auscultation is impossible (such as the scenes often encountered in emergency medicine), systolic blood pressure alone may be read by releasing the pressure until a radial pulse is palpated (felt). In veterinary medicine, auscultation is rarely of use, and palpation or visualization of pulse distal to the sphygmomanometer is used to
Sphygmomanometer
4547889
a process that can eventually lead to stomach rupture, which is inevitably fatal. Backing up of fluid through the intestinal tract is usually due to a downstream obstruction, ileus, or proximal enteritis, and its presence usually indicates a small intestinal disease. Generally, the closer the obstruction is to the stomach, the greater amount of gastric reflux will be present. Approximately 50% of horses with gastric reflux require surgery. Auscultation of the abdomen is subjective and non-specific, but can be useful. Auscultation typically is performed in a four-quadrant approach: Each quadrant should ideally be listened to for 2 minutes. Gut sounds
Horse colic
8397695
should like to draw attention to a particular bruit which has somewhat of a musical character, but is neither of sinister omen nor does it indicate endocarditis of any sort. …its characteristic feature is a twangy sound, very like that made by twanging a piece of tense string... Whenever may be its origin, I think it is clearly functional, that is to say, not due to any organic disease of the heart either congenital or acquired.”" Still's murmur is detected via auscultation with a stethoscope. It has a peculiar "musical", "resonant" or "vibratory" quality that is quite unique. It is
Still's murmur
14451089
during ventricular contraction and is normally described as "lub". The second heart sound, S2, is the sound of the semilunar valves closing during ventricular diastole and is described as "dub". Each sound consists of two components, reflecting the slight difference in time as the two valves close. S2 may split into two distinct sounds, either as a result of inspiration or different valvular or cardiac problems. Additional heart sounds may also be present and these give rise to gallop rhythms. A third heart sound, S3 usually indicates an increase in ventricular blood volume. A fourth heart sound S4 is referred
Cardiac physiology
1783512
the pulmonary artery. At the end of ventricular systole, when the pressure in the right ventricle falls rapidly, the pressure in the pulmonary artery will close the pulmonary valve. The closure of the pulmonary valve contributes the P2 component of the second heart sound. The right heart is a low-pressure system, so the P2 component of the second heart sound is usually softer than the A2 component of the second heart sound. However, it is physiologically normal in some young people to hear both components separated during inhalation. In the developing heart, the valves between the atria and ventricles, the
Heart valve
15688124
non-blinded studies are usually considered to be much lower than that of prospective clinical studies because they are prone to selection bias and retrospective bias. Published examples include Pretorius et al. Prospective clinical studies, on the other hand, are better suited to assess the true performance of a CAA system (provided that the study is blinded and well controlled). In a prospective clinical study to evaluate the performance of a CAA system, the output of the CAA system is compared to the gold standard diagnoses. In the case of heart murmurs, a suitable gold standard diagnosis would be auscultation-based expert
Computer-aided auscultation
8373818
be heard more clearly with a stethoscope. Typically, the triangle of auscultation is covered by the scapula. To better expose the floor of the triangle up of the posterior thoracic wall in the 6th and 7th intercostal space, a patient is asked to fold their arms across their chest, laterally rotating the scapulae, while bending forward at the trunk, somewhat resembling a fetal position. On the left side, the cardiac orifice of the stomach lies deep to the triangle, and in days before X-rays were discovered the sound of swallowed liquids were auscultated over this triangle to confirm an oesophageal
Triangle of auscultation
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the presystolic murmur is heard before the mitral valve produces the S1 heart sound. Less often, a presystolic murmur can be heard when a right atrial myxoma causes a tricuspid valve obstruction to blood flow. Presystolic murmur A presystolic murmur, also called presystolic accentuation, is a type of diastolic heart murmur typically associated with the opening snap in mitral valve stenosis. It is heard following the middiastolic rumble of the stenotic valve, during the diastasis phase, making it a "late diastolic" murmur. The murmur is heard due to antegrade flow of blood through a progressively narrowing mitral opening during the
Presystolic murmur
2940180
contexts). The sounds of auscultation can be depicted using symbols to produce an auscultogram. It is used in cardiology training. Mediate auscultation is an antiquated medical term for listening (auscultation) to the internal sounds of the body using an instrument (mediate), usually a stethoscope. It is opposed to immediate auscultation, directly placing the ear on the body. It was demonstrated in the 2000s that continuous Doppler enables the auscultation of valvular movements and blood flow sounds that are undetected during cardiac examination with a stethoscope in adults. The Doppler auscultation presented a sensitivity of 84% for the detection of aortic
Auscultation
5903799
a direct relation to the development of atrioventricular canal defect. AVSDs can be detected by cardiac auscultation; they cause atypical murmurs and loud heart tones. Confirmation of findings from cardiac auscultation can be obtained with a cardiac ultrasound (echocardiography - less invasive) and cardiac catheterization (more invasive). Tentative diagnosis can also be made in utero via fetal echocardiogram. An AVSD diagnosis made before birth is a marker for Down syndrome, although other signs and further testing are required before any definitive confirmation of either can be made. A variety of different classifications have been used, but the defects are usefully
Atrioventricular septal defect
3199427
decreased cardiac index), (jugular vein distention from right sided heart failure and fluid overload), distant heart sounds on auscultation, and equilibration of all the diastolic blood pressures on cardiac catheterization due to the constriction of the pericardium by the fluid. In such cases of cardiac tamponade, EKG or Holter monitor will then depict electrical alternans indicating wobbling of the heart in the fluid filled pericardium, and the capillary refill might decrease, as well as severe vascular collapse and altered mental status due to hypoperfusion of body organs by a heart that can not pump out blood effectively. The diagnosis of
Pericarditis
15688120
their ability to detect the difference between normal and abnormal heart sounds. Heart murmurs (or cardiac murmurs) are audible noises through a stethoscope, generated by a turbulent flow of blood. Heart murmurs need to be distinguished from heart sounds which are primarily generated by the beating heart and the heart valves snapping open and shut. Generally, heart murmurs are classified as innocent (also called physiological or functional) or pathological (abnormal). Innocent murmurs are usually harmless, often caused by physiological conditions outside the heart, and the result of certain benign structural defects. Pathological murmurs are most often associated with heart valve
Computer-aided auscultation
1795543
dilated congestive heart failure (CHF). S3 is thought to be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by blood rushing in from the atria. The reason the third heart sound does not occur until the middle third of diastole is probably that during the early part of diastole, the ventricles are not filled sufficiently to create enough tension for reverberation. It may also be a result of tensing of the chordae tendineae during rapid filling and expansion of the ventricle. In other words, an S3 heart sound indicates increased volume of
Heart sounds
67238
pain suggestive of a cardiovascular pathology. It would typically be modified depending on the indication and integrated with other examinations especially the respiratory examination. Like all medical examinations, the cardiac examination follows the standard structure of inspection, palpation and auscultation. Cardiology is concerned with the normal functionality of the heart and the deviation from a healthy heart. Many disorders involve the heart itself but some are outside of the heart and in the vascular system. Collectively, the two together are termed the cardiovascular system and diseases of one part tend to affect the other. Hypertension, also known as "high blood
Cardiology
3518091
others may exhibit shortness of breath, cyanosis, fainting, heart murmur, under-development of limbs and muscles, poor feeding or growth, or respiratory infections. Congenital heart defects cause abnormal heart structure resulting in production of certain sounds called heart murmur. These can sometimes be detected by auscultation; however, not all heart murmurs are caused by congenital heart defects. Congenital heart defects are associated with an increased incidence of some other symptoms, together being called the VACTERL association: Ventricular septal defect (VSD), atrial septal defects, and tetralogy of Fallot are the most common congenital heart defects seen in the VACTERL association. Less common
Congenital heart defect
390199
that both methods could complement each other. A military noise-immune Doppler based stethoscope has recently been developed for auscultation of patients in loud sound environments (up to 110 dB). A 3D-printed stethoscope is an open-source medical device meant for auscultation and manufactured via means of 3D printing. The 3D stethoscope was developed by Dr. Tarek Loubani and a team of medical and technology specialists. The 3D-stethoscope was developed as part of the Glia project, and its design is open source from the outset. The stethoscope gained widespread media coverage in Summer 2015. The need for a 3D-stethoscope was borne out
Stethoscope
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vice president. The school's name was eventually changed to Perkins School for the Blind and is now located in Watertown, Massachusetts. Dr. Fisher was a pioneer for medical reform in Boston. He is credited with introducing the stethoscope into the United States and was an early advocate for the practice of mediate auscultation—listening to the body through a stethoscope—using the techniques that he had learned during his studies in Paris with Laënnec. In July 1832, while using auscultation to examine a child affected with chronic hydrocephalus, he discovered what was called "cephalic bellows-sound" or "cerebral murmur", a phenomenon related to
John Dix Fisher
20481889
in diameter at the front and the rear. The interior of the S1 is finished mostly in leather, suede, and Alcantara. Other amenities include Sirius radio, Apple CarPlay, and a six-speaker sound system. The manufacturer claims a top speed of for the Saleen S1. The car has claimed acceleration times of 3.5 seconds for and 11.3 seconds for the quarter mile. These acceleration times are achieved through a power-to-weight ratio of 0.17 hp/lb (0.28 kW/kg). The S1 is also capable of 1.2g of lateral acceleration in a turn. Saleen S1 The Saleen S1, also called the Saleen 1, is an
Saleen S1
2898288
the cerebral cortex. The extensor response usually disappears - giving way to the flexor response - by 12 months of age. Its persistence beyond age 2-3 indicates a problem in the brain or spinal cord. Afferent: Nociception detected in the S1 dermatome and travels up the tibial nerve to the sciatic nerve to roots of L5,S1 and synapse in the anterior horn to elicit the motor response. Efferent: Motor response back through the L5,S1 roots to the sciatic nerve to its bifurcation. Toe flexors are innervated by the tibial nerve. Toe extensors (extensor hallicus longus, extensor digitorum longus) are innervated
Plantar reflex
96458
Cardiology diagnostic tests and procedures The diagnostic tests in cardiology are methods of identifying heart conditions associated with healthy vs. unhealthy, pathologic heart function. Obtaining a medical history is always the first "test", part of understanding the likelihood of significant disease, as detectable within the current limitations of clinical medicine. Yet heart problems often produce no symptoms until very advanced, and many symptoms, such as palpitations and sensations of extra or missing heart beats correlate poorly with relative heart health "vs" disease. Hence, a history alone is rarely sufficient to diagnose a heart condition. "Auscultation" employs a stethoscope to more
Cardiology diagnostic tests and procedures
8204972
produce a summation gallop where S and S occur so close as to be indistinguishable. Gallop rhythms may be heard in young or athletic people, but may also be a sign of serious cardiac problems like heart failure as well as pulmonary edema. Gallop rhythms may be associated with the following: The atrium has to contract strongly to push the blood through the stiffened ventricle. Gallop rhythm A gallop rhythm refers to a (usually abnormal) rhythm of the heart on auscultation. It includes three or four sounds, thus resembling the sounds of a gallop. The normal heart rhythm contains two
Gallop rhythm
473104
growth. More minor forms of congenital heart disease may remain undetected for many years and only reveal themselves in adult life (e.g. atrial septal defect). Heart disease is diagnosed by the taking of a medical history, a cardiac examination, and further investigations, including blood tests, echocardiograms, ECGs and imaging. Other invasive procedures such as cardiac catheterisation can also play a role. The cardiac examination includes inspection, feeling the chest with the hands (palpation) and listening with a stethoscope (auscultation). It involves assessment of signs that may be visible on a person's hands (such as splinter haemorrhages), joints and other areas.
Heart
10434882
"concentric" and "simple" hypertrophy of the heart. René-Joseph-Hyacinthe Bertin René-Joseph-Hyacinthe Bertin (1757–1828) was a French anatomist known for his pioneer work in cardiology. He was the son of anatomist Exupère Joseph Bertin (1712-1781). He was the author of "Traité des Maladies du Coeur et des Gros Vaisseaux" (Treatise of Diseases of the Heart and Major Vessels), an important work on the pathological anatomy of the heart. In this book he discusses topics such as auscultation, valvular deformities and hypertrophy of the heart. His student Jean-Baptiste Bouillaud (1796–1881) assisted him with its edition. Bertin originated the idea of having three designations
René-Joseph-Hyacinthe Bertin
3107894
secondary to mitral stenosis is severe, the P (pulmonic) component of the second heart sound (S) will become loud. An opening snap that is a high-pitch additional sound may be heard after the A (aortic) component of the second heart sound (S), which correlates to the forceful opening of the mitral valve. The mitral valve opens when the pressure in the left atrium is greater than the pressure in the left ventricle. This happens in ventricular diastole (after closure of the aortic valve), when the pressure in the ventricle precipitously drops. In individuals with mitral stenosis, the pressure in the
Mitral valve stenosis
6746692
tissue. In egophony, the person being examined continually speaks the English long-sound "E". The lungs are usually air filled, but if there is an abnormal solid component due to infection, fluid, or tumor, the higher frequencies of the "E" sound will be diminished. This changes the sound produced, from a long "E" sound to a long "A" sound. Respiratory sounds Respiratory sounds, breath sounds, or lung sounds refer to the specific sounds generated by the movement of air through the respiratory system. These may be easily audible or identified through auscultation of the respiratory system through the lung fields with
Respiratory sounds
67258
Congenital heart defects are the leading cause of birth defect-related deaths. In 2013 they resulted in 323,000 deaths down from 366,000 deaths in 1990. Diagnostic tests in cardiology are the methods of identifying heart conditions associated with healthy vs. unhealthy, pathologic heart function. The starting point is obtaining a medical history, followed by Auscultation. Then blood tests, electrophysiological procedures, and cardiac imaging can be ordered for further analysis. Electrophysiological procedures include electrocardiogram, cardiac monitoring, cardiac stress testing, and the electrophysiology study. Cardiology Cardiology (from Greek "kardiā", "heart" and "-logia", "study") is a branch of medicine dealing with disorders of the
Cardiology
10434881
René-Joseph-Hyacinthe Bertin René-Joseph-Hyacinthe Bertin (1757–1828) was a French anatomist known for his pioneer work in cardiology. He was the son of anatomist Exupère Joseph Bertin (1712-1781). He was the author of "Traité des Maladies du Coeur et des Gros Vaisseaux" (Treatise of Diseases of the Heart and Major Vessels), an important work on the pathological anatomy of the heart. In this book he discusses topics such as auscultation, valvular deformities and hypertrophy of the heart. His student Jean-Baptiste Bouillaud (1796–1881) assisted him with its edition. Bertin originated the idea of having three designations of cardiac hypertrophy, which he called "eccentric",
René-Joseph-Hyacinthe Bertin
5115498
alkyl halide groups can undergo the reaction, which would be unexpected if only an S2 mechanism was operating. Further support for this S1 type mechanism comes from the use of the Arbuzov reaction in the synthesis of neopentyl halides, a class of compounds that are notoriously unreactive towards S2 reactions. Based on the principle of microscopic reversibility, the inert nature of the neopentyl halides towards the S2 reaction indicates that an S2 reaction is unlikely to be the mechanism for the synthesis of the neopentyl halides in this reaction. Substrates that cannot react through an S2 pathway or an S1
Michaelis–Arbuzov reaction
3160954
are diagnosed "in utero" or in early childhood with the use of ultrasonography or auscultation of the heart sounds during physical examination. Some individuals with an ASD have surgical correction of their ASD during childhood. The development of signs and symptoms due to an ASD are related to the size of the intracardiac shunt. Individuals with a larger shunt tend to present with symptoms at a younger age. Adults with an uncorrected ASD present with symptoms of dyspnea on exertion (shortness of breath with minimal exercise), congestive heart failure, or cerebrovascular accident (stroke). They may be noted on routine testing
Atrial septal defect
14305004
and can lead to sustained abnormal rhythm. They are relatively rare and can result from the action of anti-arrhythmic drugs. See early and delayed Afterdepolarizations. Tachyarrhythmias are the result of spontaneous action potentials arise from cardiac muscle cells. Cardiac arrhythmia are often first detected by simple but nonspecific means: auscultation of the heartbeat with a stethoscope, or feeling for peripheral pulses. These cannot usually diagnose specific arrhythmia but can give a general indication of the heart rate and whether it is regular or irregular. Not all the electrical impulses of the heart produce audible or palpable beats; in many cardiac
Heart arrhythmia
9007275
examination including auscultation of heart and lung sounds and recording of vital signs such as heart rate and blood pressure, and increasingly, for better efforts at detection, such as an electrocardiogram. An electrocardiogram (ECG) is a relatively straightforward procedure to administer and interpret, compared to more invasive or sophisticated tests; it can reveal or hint at many circulatory disorders and arrhythmias. Part of the cost of an ECG may be covered by some insurance companies, though routine use of ECGs or other similar procedures such as echocardiography (ECHO) are still not considered routine in these contexts. Widespread routine ECGs for
Athletic heart syndrome
19366875
sounds of the heart." He became a Fellow of the Royal College of Surgeons of Edinburgh in the same year and was elected President of the Royal Medical Society in 1835. Before settling into practice in Edinburgh he made a tour of medical centres in Europe, promoting his ideas on auscultation of the heart. He then joined his father in general practice in Edinburgh and was elected a medical officer to the New Town Dispensary. He was medical officer to John Watson's Institution, to Cauvin's Hospital and was one of the original physicians to the Sick Children's Hospital in Edinburgh.
Patrick Newbigging
3298305
excavatum improves patient cardiac performance. Pectus excavatum is initially suspected from visual examination of the anterior chest. Auscultation of the chest can reveal displaced heart beat and valve prolapse. There can be a heart murmur occurring during systole caused by proximity between the sternum and the pulmonary artery. Lung sounds are usually clear yet diminished due to decreased base lung capacity. Many scales have been developed to determine the degree of deformity in the chest wall. Most of these are variants on the distance between the sternum and the spine. One such index is the "Backer ratio" which grades severity
Pectus excavatum
8911745
Whispered pectoriloquy Whispered pectoriloquy refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's torso. Usually spoken sounds of a whispered volume by the patient would not be heard by the clinician auscultating a lung field with a stethoscope. However, in areas of the lung where there is lung consolidation, these whispered spoken sounds by the patient (such as saying 'ninety-nine') will be clearly heard through the stethoscope. This increase in sound exists because sound travels faster and thus with lower loss of intensity through liquid or solid ("fluid mass"
Whispered pectoriloquy
1851725
from sleep gasping for air, crackles on lung auscultation, central venous pressure of more than 16 cm at the right atrium, jugular vein distension, positive abdominojugular test, and weight loss of more than 4.5 kg in 5 days in response to treatment (sometimes classified as a minor criterion). Minor criteria include an abnormally fast heart rate of more than 120 beats per minute, nocturnal cough, difficulty breathing with physical activity, pleural effusion, a decrease in the vital capacity by one third from maximum recorded, liver enlargement, and bilateral ankle swelling. Minor criteria are acceptable only if they can not be
Heart failure
8911749
Better phrases in English include "toy boat”, "Scooby Doo", and “blue balloons". Whispered pectoriloquy Whispered pectoriloquy refers to an increased loudness of whispering noted during auscultation with a stethoscope on the lung fields on a patient's torso. Usually spoken sounds of a whispered volume by the patient would not be heard by the clinician auscultating a lung field with a stethoscope. However, in areas of the lung where there is lung consolidation, these whispered spoken sounds by the patient (such as saying 'ninety-nine') will be clearly heard through the stethoscope. This increase in sound exists because sound travels faster and
Whispered pectoriloquy
7382169
Pioneer CLD-1010 The Pioneer CLD-1010 is a LaserDisc player introduced by Pioneer Electronics in 1987 as the last of their top-spec players not to be part of their "Elite" lineup. The player was introduced in 1987 to take over the spot previously filled by the LD-S1, Pioneer's most expensive LaserDisc player (however the later LD-S2 would be the S1's official replacement). The unit's internals were largely carryover parts from the S1, including advanced circuitry to reduce picture noise and the ability to down-convert digital soundtracks to analog for output to analog sound systems and television sets; like the S1, it
Pioneer CLD-1010
4508598
much power to a starting locomotive (by opening the steam throttle valve too much, and too quickly), and causing the wheels to slip. The S1’s duplex engine design meant that two separate engines were concurrently and in sequence exhausting into two adjoined smoke stacks. This made it nearly impossible for a locomotive engineer to distinguish the behavior of an individual engine set, based upon the sound of its exhaust. Unless both sets of engines experienced wheel slip simultaneously, the sound of the normal set would mask the sound of the set that was slipping and over speeding. If the wheels
Pennsylvania Railroad class S1
15467875
Cranial auscultation Auscultation can be performed upon the skull to check for intracranial bruits. Such a bruit may be found in such conditions as cerebral angioma, tumour of the glomus jugulare, intracranial aneurysm, meningioma, occlusion of the internal carotid artery, or increased intracranial pressure. The following extract details a method of performing cranial auscultation: A bruit should be listened for, in quiet surroundings, over the skull and eyeballs, the latter situation being the most favourable for hearing the softest ones. The patient should be asked to close both eyes gently and the stethoscope firmly applied over one eye. During auscultation
Cranial auscultation
15467876
the other eye should be opened as in this way there is considerable diminution of eyelid flutter, which may cause confusion if rhythmical. Auscultation is then carried out over the other eye in a similar manner. If a murmur is not readily heard the patient should be asked to hold his breath. Finally auscultation should be carried out over the temporal fossæ and mastoid processes. Cranial auscultation Auscultation can be performed upon the skull to check for intracranial bruits. Such a bruit may be found in such conditions as cerebral angioma, tumour of the glomus jugulare, intracranial aneurysm, meningioma, occlusion
Cranial auscultation
14136107
Imaging Lung Sound Behavior with Vibration Response Imaging Since the invention of the stethoscope by René-Théophile-Hyacinthe Laennec France in 1816, physicians have been utilizing lung sounds to diagnose various chest conditions. Today auscultation provides physicians with extensive information on the examination of the patient. The skills of the examiner however, vary, as seen in a clinical study that was conducted on the diagnosis of pneumonia in 2004. Vibration response Imaging (VRI), a novelty computer-based technology takes the concept of the stethoscope to a more progressive level. The technology is based on the physiologic vibration generated during the breathing process when
Imaging Lung Sound Behavior with Vibration Response Imaging
15554098
in uterine blood supply and reductions in cardiac output. Intermittent fetal heart auscultation and observation of vaginal discharge is used to assess the fetal condition. A partogram is recommended to facilitate monitoring during labor. During the second stage of labor, women are encouraged to assume the most comfortable position. In the second stage of labor fetal heart rate should be assessed every 15 minutes and the fetal heart rate should be assessed after each contraction while bearing down. Active management of labor with oxytocin is recommended in the third stage of labor. Medio-lateral episiotomies are recommended to expedite delivery or
Childbirth in Sri Lanka
14165014
Succussion splash Succussion splash is a sloshing sound heard through the stethoscope during sudden movement of the patient on abdominal auscultation. It reflects the presence of gas and fluid in an obstructed organ, as in gastric outlet obstruction. Physical examination can show an abdominal succussion splash, which is elicited by placing the stethoscope over the upper abdomen and rocking the patient back and forth at the hips. Retained gastric material greater than three hours after a meal will generate a splash sound and indicate the presence of a hollow viscus filled with both fluid and gas. An example would be
Succussion splash
4721400
intrinsic aspect of clinical medicine. In particular, Corvisart attentively focused on the heart and lungs as sources of lesions. His studies with these lesions led to him percussing the chest of his patients to find such wounds inside the body, studying the "organic diseases of the heart". Corvisart is also linked to Reneé Laennec, the physician who invented the stethoscope for auscultation several years later. Laennec learned of percussion from Corvisart's translation of Auenbrugger's book. Corvisart, Laennec and others also headed the so-called "Paris school" that developed new methods of medicine in the twenty hospitals of Paris. By establishing a
Jean-Nicolas Corvisart
6363327
of alterations in density may include pleural effusion and pneumothorax. The sound is described as tympanic if there is a pneumothorax because air will stretch the pleural membranes. Conversely, if there is fluid between the pleural membranes, the percussion will be dampened and sound muffled. The physician then auscultates the respiratory sounds over the lung fields, listening to the fields through a stethoscope. It is important to always place the stethoscope directly on the skin; listening over clothing makes it more difficult to distinguish between normal and abnormal breath sounds. During auscultation, the patient should take deep breaths through their
Respiratory examination
3160955
to have an abnormal chest X-ray or an abnormal ECG and may have atrial fibrillation. If the ASD causes a left-to-right shunt, the pulmonary vasculature in both lungs may appear dilated on chest X-ray, due to the increase in pulmonary blood flow. The physical findings in an adult with an ASD include those related directly to the intracardiac shunt, and those that are secondary to the right heart failure that may be present in these individuals. Upon auscultation of the heart sounds, a systolic ejection murmur may be heard that is attributed to the pulmonic valve, due to the increased
Atrial septal defect
7087652
Egophony Egophony (British English, aegophony) is an increased resonance of voice sounds heard when auscultating the lungs, often caused by lung consolidation and fibrosis. It is due to enhanced transmission of high-frequency sound across fluid, such as in abnormal lung tissue, with lower frequencies filtered out. It results in a high-pitched nasal or bleating quality in the affected person's voice. While listening to the lungs with a stethoscope, the patient is asked to pronounce the modern English (more generally, post-Great Vowel Shift) long-E vowel sound. Stethoscopic auscultation of a clear lung field during this articulation will detect a sound matching
Egophony
15736058
around the clock by Class S1 engines no. 374 and 375. By the 1970s they were distributed between Beaconsfield, Bloemfontein, Germiston, Kaserne, Springs and Witbank. By 1982 they were all stationed at Germiston and its sub-depot at Kaserne, after which they began to be withdrawn from service. The withdrawal was probably expedited by the closure of the Koedoespoort works in Pretoria to steam repairs, since it was impractical to let them do long-distance running to the next nearest steam locomotive works at Bloemfontein. None of them were sold into industrial service. The builders, works numbers, years built and SAR locomotive
South African Class S1 0-8-0
1795558
the aortic valve to close. The closure of the aortic valve contributes the A component of the second heart sound (S). Narrowing of the aortic valve is called aortic stenosis, limiting the blood that can leave the valve and increasing the force the heart has to use to pump the blood through the valve. Aortic insufficiency, also called aortic regurgitation, is when the valve is unable to close properly. As a consequence, blood passively flows back to the heart in the wrong direction. These two conditions frequently co-exist. Common causes of aortic regurgitation include vasodilation of the aorta, previous rheumatic
Aortic valve
6528044
pulmonary hypertension. This however, does not mean the cause is always congenital. The left ventricle can be changed physically, these changes are a direct result of right ventricular hypertrophy. Once the obstruction is subdued, it (the left ventricle) can return to normal. The diagnosis of pulmonary valve stenosis can be achieved via echocardiogram, as well as a variety of other means among them are: ultrasound, in which images of the heart chambers in utero where the tricuspid valve has thickening (or due to Fallot's tetralogy, Noonan's syndrome, and other congenital defects) and in infancy auscultation of the heart can reveal
Pulmonary valve stenosis
12843674
for most digital (oscillometric) non-invasive blood pressure monitors. For this reason, when determining heart rate in AF, direct cardiac auscultation is recommended. Low blood pressure is most concerning and a sign that immediate treatment is required. Many of the symptoms associated with uncontrolled atrial fibrillation are a manifestation of congestive heart failure due to the reduced cardiac output. Respiratory rate will be increased in the presence of respiratory distress. Pulse oximetry may confirm the presence of hypoxia related to any precipitating factors such as pneumonia. Examination of the jugular veins may reveal elevated pressure (jugular venous distention). Lung exam may
Atrial fibrillation
520427
auscultation, traditionally using a stethoscope and counting it for a minute. The radial pulse is commonly measured using three fingers. This has a reason: the finger closest to the heart is used to occlude the pulse pressure, the middle finger is used get a crude estimate of the blood pressure, and the finger most distal to the heart (usually the ring finger) is used to nullify the effect of the ulnar pulse as the two arteries are connected via the palmar arches (superficial and deep). The study of the pulse is known as sphygmology. Claudius Galen was perhaps the first
Pulse