Basics of heart sounds and murmurs with Cath lab Essentials


Today inshaAllah we will be talking about an interesting topic in cardiology, we will discuss heart sounds! Without further delay, let’s get into it! Heart sounds happen as a result of valve closure, namely atrioventricular valve: mitral and tricuspid and this gives us S1 sound and we have S2, which happens when aortic and pulmonic valve close. So normally we would have something like this: This is s1 and this is s2 the area between s1 and s1 is systole. in other words, when the AV valves are closed and the pulmonic and aortic valve are open, it is systole, where the blood is being pumped out of the ventricles. Now that we have this basic understanding, we are good to proceed. Abnormal heart sounds can be either of an added sound: S3, S4 for example, or can happen in the form of murmurs sometimes Murmurs can be either systolic or diastolic, whether they happen in systole or diastole So now we will focus on visualizing added sounds and murmurs while showing them simultaneously on this beautiful illustration: To make it more interactive and fun, we will give you some written clues and we will wait for a few seconds after each sound for you to try to guess before we put the answer. Now you to know whether the murmur you are hearing is systolic or diastolic, time the sound you hear with the carotid upstroke; that is when you feel the pulse that corresponds to S1, if the murmur comes immediately right after it, this is systolic murmur, if the murmur comes not with the upstroke, but after the second heart sound which is S2, that is a diastolic murmur. 

Just try to look at the heart, how it's contracting and how the valves are closing S1-S2: systole S2-S1 diastole Another thing to keep in mind, since we have S1-S2 (normal heart sounds), we also have Added sounds such as S3 and S4. As the name imply, S3 come right after S2, whereas S4 comes closer to S1 Let's imagine a patient has all of the S's, this is how it would look like. Let's get started Lastly, we will look at some disorders that can result in heart murmurs: If you understand valvular disorders, you will get more than 90% of heart murmurs correct Patients can have valvular stenosis (aka narrowing) or regurgitation, which refers to blood going opposite to the normal direction Now, We can divide heart murmurs, as we’ve seen, to systolic and diastolic murmurs To under the disorder and the murmur that corresponds to it, we need to imagine blood flow through these valves If we have stenosis in aortic or pulmonic valves, this should give us a systolic murmur, since blood normally passes through these valves in systole Whereas mitral and tricuspid stenosis would give us diastolic murmurs, again, since blood passes through these valves in diastole For regurgitation, it is the exact opposite. Normally, in diastole, aortic and pulmonic valves are closed; however, if one of these valves is regurgitant, then pts would have a diastolic murmur. Likewise, mitral and tricuspid valves are normally closed in systole, however, if they are open in systole, then this is what we call as mitral or tricuspid regurgitation, and this would give us a systole murmur. So Systolic murmurs include aortic and pulmonic stenosis, and mitral and tricuspid regurgitation. 

While diastolic murmurs include aortic and pulmonic regurgitation, and mitral and tricuspid stenosis Of course, these are not the only disorders that can result in heart murmurs, you have other conditions such as atrial septal defect (ASD) (ventricular septal defect; VSD) or Patent ductal arteriosus, and all of these can also result in heart murmurs. And with that we conclude our video we hope you found it beneficial! Please let us know what you think about our first video in Cardiology! And as always, please do not forget to like, share and subscribe to get our latest explanation. Until next time!   

Cath Lab Essentials: Patient Preparation Cases:

Hi. You or your family member have been scheduled for cardiac catheterization  procedure at St. Michael's Hospital. We want things to go as smoothly and as  comfortably as possible. This video is to help you prepare for the procedure, and  let you know what to expect on your day with us at the Cardiac Investigation Unit.  Welcome to St. Michael's Hospital. St. Michael's is the provincial hub for  the most complex cardiac and cardiovascular care. As a patient, you may also  be given an opportunity to participate in clinical research evaluating  tomorrow's treatments. You will meet not just your heart doctor but a team of  highly-qualified professionals during your stay, including registered nurses,  specialized in cardiac medicine, resident physicians in advanced specialty  training, medical X-ray and cardiac technologists. Your cardiologist has  referred you to ask for a catheter-based procedure, either a cardiac angiogram for  diagnosis or a coronary angioplasty or stent for treatment.  A cardiac catheterization is a diagnostic procedure to see if there are any  blockages in your heart arteries, or problems with the valves or pump. A fluid  called contrast or dye is injected through a catheter into your heart  arteries (or heart chambers.) X-ray movies are taken during these injections to  show the inside of your heart. The most common treatment done in the cardiac  catheterization laboratory is a coronary angioplasty, a procedure done to treat  important narrowings that obstruct blood flow to major heart arteries. 

Hi, my name is Dr. Wassef. I'm an interventional cardiology fellow at St. Michael's Hospital.  The two most common places to get access are in the femoral artery,  which is in the upper part of the thigh here where we'll put an introducer sheath  like this into it, into the upper part of the thigh. This will allow us to advance  the catheters to your heart. The other place is in the upper part of the wrist,  just below the thumb here where a catheter will be inserted.    >> One of our staff members from the Cardiac Investigation Unit will contact  you on the phone to schedule your cardiac catheterization test.  The first thing you need to do is get a set of blood tests and ECG tests at a lab near  your home. Your heart test may be delayed if we do  not have your blood and ECG test results. Please call your case manager if you do  not have the requested tests done before the date of your procedure. You will need  to arrange for someone to drive you home after the heart test. You are strongly  advised not to take public transportation, and you are not allowed  to drive for 48 hours after your heart test.  Clear your schedule: be ready to spend all day with our team in the hospital.  Emergency cases may push your test to a later time slot of the day. You may  wait anywhere from one to six hours for the test from your scheduled appointment time.  What to do the night before your heart test. Step 1: take out and write  down all the medications you are currently taking on the medication  information form. Step 2: pack your bag with your health card, all  of your medications you are currently taking, completed medication list  instruction letter and information packet from the case manager.  Step 3: stay hydrated by drinking a lot of low sugar, non-caffeinated beverages. Plain water  is the best option. In the morning of your heart test, it is important to take  all your usual heart and blood pressure medications unless your doctor and case  manager told you to stop. Before you leave your house, make sure to bring the  bag you packed the night before, and ensure that you have a ride home. There are (three)  entrances to the hospital. We recommend you enter through the Queen St. entrance.  The Cardiac Investigation Unit, also  known as CIU, is located on the 7th floor Cardinal Carter wing.  Take the north elevators. When you step off the elevator  on the 7th floor Cardinal Carter wing, you will be directed to wait in the  patient and visitor waiting area outside the Cardiac Investigation Unit.  The nurse will ask you questions about your health history, take your vital  signs and review the medications you are taking. Remember to bring all your  medications, as well as the list of medications you are currently taking.  The nurse will then disinfect and clean the skin, and insert an intravenous into your arm.  The doctor will talk to you and get your consent for the procedure while  you're waiting in the CIU. A nurse from the procedure room will  come and take you on a stretcher into the room. Once you are in the room, you  will lie flat on a narrow table under an X-ray camera. When you are comfortable on  the table, you will be asked not to move any parts of your body unless asked by  the doctor or other staff in the room. The team in the room will use a cold and  wet solution to clean the areas where the test equipment enters your body.  These areas could include top of your leg and your wrist. The team will put a  sterile drape over your body. Before the test begins, the nurse will give you  medications and IV to help with any anxiety or pain you may experience.  However, you will be awake during the procedure. Once you are prepared, the  doctor will enter the procedure room. The doctor will begin by putting a local  anesthetic to numb the area where a long thin tube is placed inside an artery.  The tube allows access for other equipment to be guided into your heart.  The freezing medicine, so you do not feel any pain or discomfort. After the test is  done, the CIU team will help you move to a stretcher. If the test was done through  the wrist, the doctor will take the tube out in the procedure room and put a  tight clamp around your wrist to stop the bleeding.  >>Hi I'm Dr. Buller. I thought I'd come and introduce myself to you, and make sure that we've answered any  of your questions. Naturally we can't put catheters into  the heart without some small risks, and there are some small risks to this procedure.  For healthy people the risks are pretty tiny, but they do include the  risk of major heart attack, the risk of stroke, which can be very serious, and of  course a tiny but definite risk of death. And sometimes the X-ray contrast we use  can be difficult with respect to kidney injury,  and sometimes people have allergic reactions to the medicines and to  the contrast that we use. But we're prepared to handle that, and this is a  very experienced centre. The team is all very experienced, and if we do encounter  a complication, we know how to deal with it promptly. Sometime before you go home,  either the fellow or I will come and have a conversation with you and your  family, make sure you understand the results of the tests, whether any other  tests or appointments are necessary as a result of it. And we're going to give you  a diagram that shows where the blockages in your heart are and we'll go over that  with you and suggest that you keep that with you for your future medical  appointments with your specialists and with your family doctor.    >> Thank you for taking the time to prepare for your procedure. We hope this articlde has helped.