Cardiology Core Curriculum: A Problem Based Approach by Leszek Rutkowski, Jörg Siekmann, Ryszard Tadeusiewicz, Lotfi

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By Leszek Rutkowski, Jörg Siekmann, Ryszard Tadeusiewicz, Lotfi A. Zadeh

This textbook covers the entire major subspecialties in cardiology, together with a wide percentage of case experiences that illustrate the rules of scientific perform. Self checking out questions accompany every one case. Authored via top cardiologists, this can be an up to the moment, good illustrated, middle cardiological textual content for these getting ready for the professional examinations.

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6 Obstructive hypertrophic cardiomyopathy. 6), S1 is normal and S2 is split normally on inspiration. There is a prominent S4. A mid to late systolic ejection murmur is heard at the left sternal edge and apex. The murmur typically increases with Valsalva maneuver. When mitral regurgitation is present, an apical, holosystolic murmur is heard and may be accompanied by an S3. The chest and abdominal examinations are normal. There is no peripheral edema. 4 Distinguishing examination features of obstructive hypertrophic cardiomyopathy and aortic valve stenosis Feature Pulse Murmur Obstructive hypertrophic cardiomyopathy Aortic valve stenosis Bisferiens or “jerky”, with a brisk arterial upstroke Ejection systolic; increases with Valsalva (which decreases stroke volume) with or without mitral holosystolic Slow rising, low volume, and sustained Ejection systolic; increases with squatting (which increases stroke volume) waves (narrow and deep) caused by hypertrophy of the septal region (a “pseudo-infarction” appearance).

2 Echocardiographic imaging of the heart through the chest wall is limited to the left parasternal, apical, subxiphoid, and suprasternal regions, where the heart is close to the chest wall. This is because the transmitted and reflected ultrasound signals are attenuated by the air contained in lung tissue. Twodimensional echocardiographic imaging from the esophagus and stomach is of much higher quality because the esophagus lies directly behind the heart with no intervening lung tissue. A routine two-dimensional echocardiographic examination consists of obtaining short axis sections at the aortic valve level, the left ventricle and right ventricle at the levels of the mitral valve and papillary muscles, as well as a long axis image of the left ventricle from the left parasternal region.

5 Aortic valve stenosis. S1, first heart sound; S2, second heart sound; S4, fourth heart sound. Single S2 (because A2 is delayed and merges with P2); ejection systolic murmur; S4 often present. A2, aortic component of the second heart sound; P2, pulmonary component of the second heart sound If the pulse is slow rising, low volume, and sustained, S2 is single, and the typical ejection systolic murmur is long and late peaking, then it is likely that severe, aortic valve stenosis is present.

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