Cardiology Dr.

Shaf3y

cardiology

cardiology

2013

shock

13

cardiology
6

GIT
endocrine
urology
orthopedic
complications of blood transfusion

cardiology
cardio-thorax surgery

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GIT
Thyroid
Nephrology
Rheumatology
Hematology

cardiology

Cardiology Dr. Shaf3y

cardio-thorax surgery
blunt trauma
Pericardial effusion
blunt trauma
Pericardial effusion

chest
thorax
pneumothorax pleural effusion empyema
already
trauma to the chest
blunt trauma
hematology
complication of blood transfusion

complications of blood transfusion

Liver
portal hypertension

Liver
amebic liver abscess

GIT
Liver
Hepatic injury

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Cardiology Dr. Shaf3y

Home work

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Cardiology Dr. Shaf3y

( forensic

scientific

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Cardiology Dr. Shaf3y

Which means

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Cardiology Dr. Shaf3y

Friday

please

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Cardiology Dr. Shaf3y

Cardiology
<< cardiology
cardiology

general rules

cardiology
4 chambers
heart

body
inferior vena cava

superior

right atrium
right ventricle
tricuspid valve
right pulmonary artery

right ventricle
Lung

body
Lung

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Cardiology Dr. Shaf3y

Lung
pulmonary veins
left atrium
left ventricle left atrium
mitral valve
aorta

Lung
body

cardiology
cardiology
etiology

disease
disease

Pathology
clinical pictures
disease
clinical pictures
cardiology
disease
items
asymptomatic

Mild mitral stenosis

chest infection
Murmur
Mild mitral stenosis
echo
Mild
aortic stenosis
asymptomatic

Tricuspid stenosis - tricuspid regurge - pulmonary stenosis - pulmonary regurge

Right ventricular failure - pulmonary embolism

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Cardiology Dr. Shaf3y

lung
systemic congestion
systemic congestion
Ascites and lower limb edema
pain in epigastrium and right hypochondrium
dyspepsia
GIT congestion

dyspnea
systemic congestion

right sided lesion

lung
pleural effusion

main
pain in right hypochondrium and epigastrium
dyspepsia Lower limb edema ascites

aortic stenosis, aortic regurge, mitral stenosis, mitral regurge, left

ventricular failure, left ventricular infarction
left
Left side
Left side
pulmonary congestion

lung

pulmonary congestion
Dyspnea, cough, hemoptysis
recurrent chest infection
recurrent chest infection
common

hemoptysis

cough

Dyspnea

symptoms
common symptoms
common symptoms
Low cardiac output

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Cardiology Dr. Shaf3y

Low cardiac output
Lung
left side
Low cardiac output

Lung
low cardiac output

C.N.S

syncope

headache
brain

syncope
cardiovascular system

low cardiac output

dizziness
cardiac output
dizzy
low cardiac output
angina

cardiac output
coronary arteries
lower limbs

Low cardiac output

fatigue

kidney

Low cardiac output

Oliguria

syncope

headache

fatigue

dizziness << C.N.S.

angina << heart
oliguria << kidney
<< Lower limbs
symptoms
<< Palpitation

arrhythmia
arrhythmia
Palpitation

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Cardiology Dr. Shaf3y

symptoms of the course
symptoms of complications

signs
general examination
Local examination
general examination
general examination
No signs
mild aortic stenosis
general examination
mild mitral stenosis

systemic congestion
systemic congestion
Lower limb edema
ascites
enlarged tender liver
congested neck veins

lung congestion
bilateral basal crepitation

weak pulse

common signs
common signs
low cardiac output
low blood pressure
common signs
low cardiac output

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Cardiology Dr. Shaf3y

Low blood pressure

weak pulse

low cardiac output

arrhythmia

symptoms
signs
low cardiac output << symptom
weak pulse and low blood pressure
<< signs
palpitation
Arrhythmia
signs of the course
signs of the complications

palpation

inspection

Local examination
Local examination
<< Local examination
cardiology

percussion

auscultation
palpation
inspection
Palpation
inspection
heart
center
right ventricle
left ventricle

Left ventricle

Left atrium

Heart

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Cardiology Dr. Shaf3y

inspection and palpation

Apex
Left parasternal
Pulmonary area
Aortic area
Epigastric

apex

site
character
area
thrill

apex
Normally
left 5 intercostal space within the mid clavicular line
th

Within mid clavicular line

mid clavicular line
mid clavicular line

apex
sternum
Mid clavicular line
Within
on

Mid clavicular line

sternum
normal
apex
Mid clavicular line
abnormal

Mid clavicular line

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Cardiology Dr. Shaf3y

Left ventricle
apex
shifted outward and downward << apex
Mid clavicular line
6th space

Outwards
Downward

downward and outward

right ventricle
right ventricle
shifted
apex
Outward
Outward
Mid clavicular line
5th space

contraction

aortic stenosis
ventricle

character
stenosis
<< aortic stenosis

apex
ventricle
forcible sustained
heaving apex
forcible sustained

heaving

Heaving
forcible sustained

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Cardiology Dr. Shaf3y

regurge
ventricle

regurge

regurge
Ventricular dilatation

ventricle
starling law
stretch

contractility

dilated << ventricle

stretched
<< force of contraction
apex

regurge
apex
regurge
apex
hyper dynamic
heaving << stenosis
hyper dynamic << regurge
character
area
Left ventricle

apex
pointed

left ventricle

apex
Maximum

maximum
pulsation

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apex

Cardiology Dr. Shaf3y

Pointed

left ventricle

apex
Maximum

pulsation
localized apex
localized

Maximum

left ventricular enlargement

apex
Left ventricle
Localized << apex

right ventricle
apex
right ventricle
Pointed
border
right ventricle
even
apex
diffuse
apex
localized

apex
Left ventricle
diffuse
right ventricle
area

apex
mitral

thrill
thrill

Mitral
vibration
thrill

apex

Mitral regurge

apex
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thrill

Mitral stenosis
apex
thrill
mitral

Cardiology Dr. Shaf3y

Para sternal area
3 and 4 spaces
Heart
rd

th

para sternal area

para sternal area

Normal
right ventricle
para sternal pulsation

para sternal area

pulsation
right ventricular enlargement
right ventricle
pulsation
para sternal area
right ventricular enlargement
thrill
VSD

pulmonary area
2 left space
nd

pulmonary
chest

pulmonary artery
pulmonary artery
pulmonary artery

pulmonary artery
pulmonary hypertension
Pulmonary area
pulmonary hypertension
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pulsation

Cardiology Dr. Shaf3y

diastolic shock
pulmonary area

Pulsation
Diastolic shock

thrill
pulmonary stenosis
pulmonary regurge
pulmonary stenosis
pulmonary valve
Pulmonary artery
turbulence
right ventricle

regurge

Pulmonary stenosis
thrill
pulmonary area
pulmonary regurge
stenosis
regurge

chest wall

Aortic area
aortic
aorta
aorta

chest wall
aorta
aortic aneurysm
Hypertension
aortic aneurysm
hypertension
aortic area

thrill
Aortic stenosis
epigastric area
Liver
right ventricle

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Cardiology Dr. Shaf3y

aorta
pulsation
right ventricular enlargement
pulsation
Pulsating liver

Aorta
Normal

aorta
thin
Which is rare in Egypt

abdominal aortic aneurysm

Auscultation
ancient

hematology
Hematology

sleep apnea
sleep apnea

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Cardiology Dr. Shaf3y

auscultation
cardiac cycle

cardiac cycle
Systole
Diastole

contraction

systole
systole
atrium

ventricle

systole is ventricular contraction

relax
relax

diastole
ventricle
ventricle
atrium
diastole systole
ventricles

diastole
ventricle
diastole
Relax
systole
diastole

immediately
systole

diastole

systole
diastole

systole
contraction

systole
ventricle
contraction

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Cardiology Dr. Shaf3y

aorta
aortic valve
mitral valve
systole
systole
aortic valve
already << Mitral
ventricle
diastole
aortic valve

systole
already << Mitral
ventricle
diastole

relaxation

ventricle
pressure

volume
Isometric relaxation phase
Isometric relaxation phase
volume

Isometric
diastole

relax
atrium

ventricle

ventricle
Pressure
Pressure
mitral

Passive filling phase

according to pressure gradient
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Cardiology Dr. Shaf3y

70 %
passive filling phase

30 %

contraction

atrium
30 %

diastole
Atrial contraction
ventricular relaxation diastole

30 %
ventricle
Pressure
Mitral valve
ventricle

systole
ventricle

contract

systole

ventricle
pressure

isometric contraction phase

Isometric contraction phase
contract
ventricle

pressure

ventricle
Pressure
aorta
aortic valve

Rapid ( maximum ) ejection phase

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Cardiology Dr. Shaf3y

maximum ejection
protodiastolic phase reduced ejection

diastole
Isometric relaxation phase
Passive filling phase

70 %
30 %

atrial contraction

systole
Isometric contraction phase
Ejection phase

auscultation
Heart sounds
auscultation

ejection click

opening snap

fourth

third

heart sounds
Heart sounds
second
first

first heart sound

closure of the mitral and tricuspid valves
MCQ

10

first heart sound

closure of mitral and tricuspid valves

tricuspid

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Mitral
diastole

Cardiology Dr. Shaf3y

ventricle

diastole

Mitral
systole
systole

systole

diastole

mitral
systole
first heart sound
This is beginning of systole
tricuspid

Mitral

closure of mitral and tricuspid valves

tricuspid areas
Mitral
tricuspid
Mitral
first heart sound
tricuspid
apex
first heart sound
regurge

stenosis

introduction
introduction
background

first heart sound

first heart sound

Do you know the description of the siphon ??

Have you seen the siphon before ???
cover
is

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Cardiology Dr. Shaf3y

Heart

mitral valve

left ventricle

heart
left ventricle
Left atrium

Left atrium
left ventricle
Left ventricle
cusps

cusps
diastole

contract

ventricle
systole
valves
first heart sound

first heart sound

cusps

first heart sound

ventricle

first heart sound

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Cardiology Dr. Shaf3y

tricuspid stenosis

mitral stenosis

cusps
ventricle

contract

floating

first heart sound

mitral stenosis

tricuspid stenosis

tachycardia
ventricle
first heart sound
tachycardia

first heart sound

contact

cusps

cusps
contract

mitral stenosis

Mitral regurge
tricuspid regurge
bradycardia
filling
ventricle
already

first heart sound

tricuspid stenosis
tachycardia
first heart sound
Mitral regurge

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Cardiology Dr. Shaf3y

tricuspid regurge
bradycardia

apex
first heart sound
tricuspid
Mitral stenosis
mitral

tricuspid
Tricuspid stenosis

Tachycardia
mitral and tricuspid stenosis

Mitral

tricuspid
tachycardia

apex
Mitral regurge
tricuspid
Tricuspid regurge

Bradycardia

second heart sound

Closure of aortic and pulmonary valves
diastole

systole
systole
aorta

during systole << aorta

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Cardiology Dr. Shaf3y

diastole
aortic and pulmonary
second heart sound

second heart sound

closure of aorta and pulmonary

aortic and pulmonary area

second heart sound

pulmonary
aorta
aorta
aortic valve
pressure
left ventricle

pressure
cusps
second heart sound

Hypertension

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second heart sound

pulmonary hypertension
pulmonary hypertension
systemic

Cardiology Dr. Shaf3y

second heart sound
pressure
Pressure
Aortic stenosis
pulmonary stenosis
shock
pulmonary regurge aortic reguge
pulmonary regurge
aortic regurge

cusps

second heart sound

systemic hypertension
Pulmonary hypertension

aortic stenosis
aortic regurge
pulmonary stenosis
pulmonary regurge
splitting of the second heart sound
narrow splitting
reverse splitting
wide splitting

splitting

3/4

splitting

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Cardiology Dr. Shaf3y

second heart sound

closure of aorta and pulmonary
pulmonary

aorta

aorta
pulmonary
pulmonary

Pressure

aorta

aortic valve
Pulmonary

Normal
Normal

venous return
right atrium
right ventricle
right ventricle
pulmonary
aorta
aorta

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pulmonary
pulmonary

Cardiology Dr. Shaf3y

Normal
inspiration

venous return
right atrium
right ventricle
right ventricle
pulmonary
normal
splitting of the second heart sound

expiration

wide splitting of the second heart sound

wide splitting
second heart sound
expiration

Two sounds
inspiration

pulmonary stenosis
right bundle branch block

pulmonary stenosis
pulmonary stenosis

pulmonary stenosis
right ventricle

right ventricle
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pulmonary stenosis

Cardiology Dr. Shaf3y

pulmonary
aorta
wide splitting

pulmonary stenosis
inspiration
expiration
expiration

splitting

pulmonary stenosis
inspiration << during
right ventricle
right ventricle

pulmonary

expiration
right ventricle
pulmonary stenosis
inspiration
aorta

Pulmonary

expiration
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splitting
inspiration

Cardiology Dr. Shaf3y

More evident in inspiration
second heart sound
inspiration

expiration

two sounds

right bundle branch block

SA node
AV node
left bundle
right bundle
At the same time
to activate both ventricles at the same time

left

right bundle
bundle of His
left
activation
wall
right
right

activation

right ventricle
aorta
pulmonary
expiration
inspiration
splitting

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Cardiology Dr. Shaf3y

ASD
ASD

wide splitting

right atrium

left atrium

right ventricle

ASD
80 %

right bundle branch block

ASD
right bundle branch block

80 %

narrow splitting
inspiration
aortic stenosis
Left bundle branch block
patent ductus

aorta
Pulmonary

Pulmonary

Pulmonary
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aortic stenosis
aorta

aorta

Cardiology Dr. Shaf3y

pulmonary
Two sounds

aortic stenosis

pulmonary

aorta

Pulmonary

Narrow splitting
wide splitting
reversed splitting
narrow splitting
More severe

pulmonary

narrow splitting
aorta

aortic stenosis
Pulmonary

aorta
reversed splitting

Now
3 heart sound
Is a pathological sound
Which means
In most cases
rd

in most cases <<

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Cardiology Dr. Shaf3y

third heart sound
disease
third heart sound
third heart sound
ventricle

atrium
ventricle
ventricle

ventricle atrium
ventricle

wall
vibration
third heart sound

ventricle
ventricle

atrium

atrium
third heart sound
is flappy << ventricle
ventricle
ventricle atrium
vibration
third heart sound

ventricle
third heart sound
tricuspid
apex

flappy
MI

ventricle
heart failure
angina
ischemia

third heart sound

Increased blood flow from the atrium to the ventricle
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Cardiology Dr. Shaf3y

flappy myocardium
flappy

myocardium
heart failure
ischemia

Myocarditis

tricuspid

apex
third heart sound
right ventricular failure
flappy
myocardium
tricuspid
third heart sound

Left ventricular failure

third heart sound
apex

Normal

very rare , very rare <<

third heart sound

30
third heart sound
Normal

third heart sound

30
pathological

The third heart sound is abnormal sound

third heart sound

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Cardiology Dr. Shaf3y

first heart sound
second heart sound
S2 S1
systole
S1 S2
diastole
phase
diastole
Isometric relaxation phase
Passive filling
Atrial contraction
third
ventricle

atria

during diastole
third
Diastole
isometric relaxation
Phase

ventricle

atrium

ventricle

third heart sound

atrium
passive filling phase
third heart sound

atrium
ventricle

wall

third heart sound

diastole

second heart sound

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Cardiology Dr. Shaf3y

second heart sound
isometric relaxation phase

Fourth heart sound

4th heart sound

powerful atrial contraction

atrium
ventricle
contraction
atrium
ventricle
4th heart sound
ventricle

fourth heart sound

atrial contraction

powerful atrial contraction

ventricle
wall
4th heart sound

contraction
atrial
ventricle
pressure

pressure

atrial

ventricle
atrium
contract
atrium
ventricle
pressure
ventricle

Pressure

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fourth heart sound

Cardiology Dr. Shaf3y

ventricle

pressure
Systemic hypertension
Pulmonary hypertension

Systemic hypertension
pulmonary hypertension
aortic stenosis
pulmonary stenosis
pressure

ventricle

contraction

contraction
atrium

atriaum
mitral stenosis
Mitral stenosis
fourth heart sound

4th heart sound

mitral stenosis
contraction
atrium
th
4 heart sound
contraction
mitral stenosis

tricuspid stenosis
Mitral stenosis
fourth heart sound
fourth heart sound
4th heart sound
atrial sound
pre systolic sound

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Cardiology Dr. Shaf3y

Ejection click
ejection click
pulmonary
aorta
pulmonary
aorta
pulmonary

aorta

pulmonary stenosis
aortic stenosis
pulmonary hypertension Systemic hypertension
fourth

fourth

first heart sound

first heart sound

fourth

ejection click
I dont think so

4th heart sound

ejection click
th
4 heart sound
ejection click
aortic stenosis
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Cardiology Dr. Shaf3y

fourth
ejection click
ejection click

fourth
exceptions

4th
ejection click
pulmonary
aorta

pulmonary area

aortic area

opening snap
tricuspid
Mitral
tricuspid stenosis
mitral stenosis
opening snap
Opening snap
Is the sound of the opening of the mitral valve in patients with mitral stenosis and tricuspid stenosis

third heart sound

passive filling phase

Isometric relaxation phase

70 %
opening snap
second heart sound
isometric relaxation phase
third

third heart sound

by the character
opening snap third

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Cardiology Dr. Shaf3y

fourth

accentuated first heart sound

Normal
abnormal

timing
second

first

second

cardiology

axilla
mitral regurge

murmur

apex
Murmur
double mitral

murmur
double mitral

axilla
mitral regurge
apex

axilla
murmur

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apex

Cardiology Dr. Shaf3y

aorta
murmur
mitral stenosis
Murmur
aortic regurge
apex

accentuation

presystolic

axilla
murmur
apex
diastolic systolic timing

murmur

aorta

axilla
apex
murmur
gradullay
Murmur
mitral stenosis
murmur
aortic regurge

aorta

clavicle
murmur
aortic stenosis

cardiology
14
2013
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Cardiology Dr. Shaf3y

www.facebook.com/dr.tafreegh

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