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Fourth Heart Sound
The fourth heart sound or S4 is an extra heart sound that occurs during late diastole, immediately before the normal two "lub-dub" heart sounds (S1 and S2). It occurs just after atrial contraction and immediately before the systolic S1 and is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle. This produces a rhythm classically compared to the cadence of the word " Tennessee." One can also use the phrase "A-stiff-wall" to help with the cadence (a S4, stiff S1, wall S2), as well as the pathology of the S4 sound. Physiology The normal heart sounds, S1 and S2, are produced during the closing of the atrioventricular valves and semilunar valves, respectively. The closing of these valves produces a brief period of turbulent flow, which produces sound. The S4 sound occurs, by definition, immediately before S1, while the atria of the heart are vigorously contracting. It is manifest as a vibration of 20 to 30 Hz within ...
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Cardiology
Cardiology () is a branch of medicine that deals with disorders of the heart and the cardiovascular system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians who specialize in this field of medicine are called cardiologists, a specialty of internal medicine. Pediatric cardiologists are pediatricians who specialize in cardiology. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of general surgery. Specializations All cardiologists study the disorders of the heart, but the study of adult and child heart disorders each require different training pathways. Therefore, an adult cardiologist (often simply called "cardiologist") is inadequately trained to take care of children, and pediatric cardiologists are not trained to treat adult heart disease. Surgical aspects are not included in ...
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Heart Sound
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'' that occur in sequence with each heartbeat. These are the first heart sound (S1) and second heart sound (S2), produced 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 S3 and S4. 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 ...
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Systole (medicine)
Systole ( ) is the part of the cardiac cycle during which some chambers of the heart contract after refilling with blood. The term originates, via New Latin, from Ancient Greek (''sustolē''), from (''sustéllein'' 'to contract'; from ''sun'' 'together' + ''stéllein'' 'to send'), and is similar to the use of the English term ''to squeeze''. The mammalian heart has four chambers: the left atrium above the left ventricle (lighter pink, see graphic), which two are connected through the mitral (or bicuspid) valve; and the right atrium above the right ventricle (lighter blue), connected through the tricuspid valve. The atria are the receiving blood chambers for the circulation of blood and the ventricles are the discharging chambers. In late ventricular diastole, the atrial chambers contract and send blood to the larger, lower ventricle chambers. This flow fills the ventricles with blood, and the resulting pressure closes the valves to the atria. The ventricles now perfor ...
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Tennessee
Tennessee ( , ), officially the State of Tennessee, is a landlocked state in the Southeastern region of the United States. Tennessee is the 36th-largest by area and the 15th-most populous of the 50 states. It is bordered by Kentucky to the north, Virginia to the northeast, North Carolina to the east, Georgia, Alabama, and Mississippi to the south, Arkansas to the southwest, and Missouri to the northwest. Tennessee is geographically, culturally, and legally divided into three Grand Divisions of East, Middle, and West Tennessee. Nashville is the state's capital and largest city, and anchors its largest metropolitan area. Other major cities include Memphis, Knoxville, Chattanooga, and Clarksville. Tennessee's population as of the 2020 United States census is approximately 6.9 million. Tennessee is rooted in the Watauga Association, a 1772 frontier pact generally regarded as the first constitutional government west of the Appalachian Mountains. Its name derives from " Ta ...
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Heart Valve
A heart valve is a one-way valve that allows blood to flow in one direction through the chambers of the heart. Four valves are usually present in a mammalian heart and together they determine the pathway of blood flow through the heart. A heart valve opens or closes according to differential blood pressure on each side. The four valves in the mammalian heart are two atrioventricular valves separating the upper atria from the lower ventricles – the mitral valve in the left heart, and the tricuspid valve in the right heart. The other two valves are at the entrance to the arteries leaving the heart these are the semilunar valves – the aortic valve at the aorta, and the pulmonary valve at the pulmonary artery. The heart also has a coronary sinus valve, and an inferior vena cava valve, not discussed here. Structure The heart valves and the chambers are lined with endocardium. Heart valves separate the atria from the ventricles, or the ventricles from a blood vesse ...
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Exhalation
Exhalation (or expiration) is the flow of the breath out of an organism. In animals, it is the movement of air from the lungs out of the airways, to the external environment during breathing. This happens due to elastic properties of the lungs, as well as the internal intercostal muscles which lower the rib cage and decrease thoracic volume. As the thoracic diaphragm relaxes during exhalation it causes the tissue it has depressed to rise superiorly and put pressure on the lungs to expel the air. During forced exhalation, as when blowing out a candle, expiratory muscles including the abdominal muscles and internal intercostal muscles generate abdominal and thoracic pressure, which forces air out of the lungs. Exhaled air is 4% carbon dioxide, a waste product of cellular respiration during the production of energy, which is stored as ATP. Exhalation has a complementary relationship to inhalation which together make up the respiratory cycle of a breath. Exhalation and gas exc ...
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Human Sternum
The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Shaped roughly like a necktie, it is one of the largest and longest flat bones of the body. Its three regions are the manubrium, the body, and the xiphoid process. The word "sternum" originates from the Ancient Greek στέρνον (stérnon), meaning "chest". Structure The sternum is a narrow, flat bone, forming the middle portion of the front of the chest. The top of the sternum supports the clavicles (collarbones) and its edges join with the costal cartilages of the first two pairs of ribs. The inner surface of the sternum is also the attachment of the sternopericardial ligaments. Its top is also connected to the sternocleidomastoid muscle. The sternum consists of three main parts, listed from the top: * Manubrium * Body (gladiolus) * ...
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Inhalation
Inhalation (or Inspiration) happens when air or other gases enter the lungs. Inhalation of air Inhalation of air, as part of the cycle of breathing, is a vital process for all human life. The process is autonomic (though there are exceptions in some disease states) and does not need conscious control or effort. However, breathing can be consciously controlled or interrupted (within limits). Breathing allows oxygen (which humans and a lot of other species need for survival) to enter the lungs, from where it can be absorbed into the bloodstream. Other substances – accidental Examples of accidental inhalation includes inhalation of water (e.g. in drowning), smoke, food, vomitus and less common foreign substances (e.g. tooth fragments, coins, batteries, small toy parts, needles). Other substances – deliberate Recreational use Legal – helium, nitrous oxide (" laughing gas") Illegal – various gaseous, vaporised or aerosolized recreational drugs Medical use D ...
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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 Horse gait#Gallop, gallop. The normal heart rhythm contains two audible heart sounds called S1 and S2 that give the well-known "lub-dub" rhythm; they are caused by the closing of Heart valve, valves in the heart. The first heart sound (S1) is closure of the valve at the end of ventricular filling (the tricuspid and mitral valves); the second heart sound (S2), is closure of the aortic and/or the pulmonary valves as the ventricles relax. Extra sounds, (third heart sound, third and/or fourth heart sound, can be normal, especially in children, or with severe exercise, but are generally heard (on the left side) when ventricular function is impaired, e.g., in case of acute infarction or severe cardiac failure. The sounds are thought to be caused by the atrium, facing back-pressure, forcing volume into an incompletely emptied ventricle. Th ...
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Third Heart Sound
The third heart sound or S3 is a rare extra heart sound that occurs soon after the normal two "lub-dub" heart sounds (S1 and S2). S3 is associated with heart failure. Physiology It occurs at the beginning of the middle third of diastole, approximately 0.12 to 0.18 seconds after S2. This produces a rhythm classically compared to the cadence of the word "Kentucky" with the final syllable ("''-CKY''") representing S3. One may also use the phrase "Slosh’-ing-IN" to help with the cadence (Slosh S1, -ing S2, -in S3), as well as the pathology of the S3 sound, or any other number of local variants. S3 may be normal in people under 40 years of age and some trained athletes but should disappear before middle age. Re-emergence of this sound late in life is abnormal and may indicate serious problems like heart failure. The sound of S3 is lower in pitch than the normal sounds, usually faint, and best heard with the bell of the stethoscope. It has also been termed a ventricular gallop or a ...
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Heart Rate
Heart rate (or pulse rate) is the frequency of the heartbeat measured by the number of contractions (beats) of the heart per minute (bpm). The heart rate can vary according to the body's physical needs, including the need to absorb oxygen and excrete carbon dioxide, but is also modulated by numerous factors, including, but not limited to, genetics, physical fitness, stress or psychological status, diet, drugs, hormonal status, environment, and disease/illness as well as the interaction between and among these factors. It is usually equal or close to the pulse measured at any peripheral point. The American Heart Association states the normal resting adult human heart rate is 60–100 bpm. Tachycardia is a high heart rate, defined as above 100 bpm at rest. Bradycardia is a low heart rate, defined as below 60 bpm at rest. When a human sleeps, a heartbeat with rates around 40–50 bpm is common and is considered normal. When the heart is not beating in a regular pattern, this is refer ...
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Tachycardia
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal (such as with exercise) or abnormal (such as with electrical problems within the heart). Complications Tachycardia can lead to fainting. When the rate of blood flow becomes too rapid, or fast blood flow passes on damaged endothelium, it increases the friction within vessels resulting in turbulence and other disturbances. According to the Virchow's triad, this is one of the three conditions that can lead to thrombosis (i.e., blood clots within vessels). Causes Some causes of tachycardia include: * Adrenergic storm * Anaemia * Anxiety * Atrial fibrillation * Atrial flutter * Atrial tachycardia * Atrioventricular reentrant tachycardia * AV nodal reentrant tachycardia * Brugada syndrome * Circulatory shock and its various causes ( ...
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