EKG and Heart Murmur Review - Part 1

Summary

This video review focuses on basic EKG interpretation and cardiac auscultation, with a series of five clinical cases to illustrate the application of these skills. Each case includes a patient history, heart sounds audio, and an EKG, prompting viewers to deduce a unifying diagnosis. Topics include aortic stenosis, left ventricular hypertrophy, chronic aortic regurgitation, COPD, and flow murmurs in pregnancy. The cases help build skills in interpreting heart sounds, EKG findings, and understanding their connection to common cardiac conditions, offering a practical, case-based approach to learning.

Takeaways

• 😀 The video is a review of basic EKG interpretation and cardiac auscultation, and it is designed as an exercise for viewers to apply skills to clinical scenarios.
• 😀 The learning objective is to deduce the most likely unifying diagnosis by analyzing heart sounds, murmurs, and EKG readings in clinical cases.
• 😀 Each case includes a one-line history, an audio clip of the patient's heart sounds, and an EKG, with a focus on auscultation, EKG interpretation, and diagnosis.
• 😀 Cardiac auscultation is categorized into four types: normal sounds, abnormal heart sounds, extra sounds, and heart murmurs.
• 😀 Heart murmurs can be described by their duration (e.g., holosystolic or Crescendo-decrescendo) and their acoustic qualities, such as harshness or blowing sound.
• 😀 EKG analysis focuses on rhythm, axis, voltage, and repolarization abnormalities, with an emphasis on left ventricular hypertrophy (LVH) and strain patterns.
• 😀 In case 1, a 72-year-old man with exertional chest pain, the combination of a harsh Crescendo-decrescendo murmur and LVH suggests a diagnosis of aortic stenosis.
• 😀 In case 2, a 65-year-old woman with hypertension and exertional dyspnea, the presence of an S4 sound and LVH suggests the diagnosis of diastolic heart failure due to long-standing hypertension.
• 😀 In case 3, a 32-year-old man with scoliosis, the presence of both systolic and diastolic murmurs, and a pattern of LVH points to chronic aortic regurgitation and a possible diagnosis of Marfan syndrome.
• 😀 In case 4, a 70-year-old man with soft heart sounds and low-voltage EKG findings, the diagnosis of COPD is supported by an incomplete right bundle branch block and pulmonary disease pattern.

Q & A

What is the main learning objective of the video?

The main objective is to apply skills of cardiac auscultation and EKG interpretation to a clinical scenario in order to deduce a unifying diagnosis.

What are phonocardiograms and how are they used in the video?

Phonocardiograms are visual representations of heart sounds, recorded as sound waves. They are used in the video to help explain the characteristics of murmurs and other heart sounds.

What are the key EKG findings associated with left ventricular hypertrophy (LVH)?

The key EKG findings for LVH include prominent QRS voltage, particularly in leads like AVL, V4, and V5, with secondary repolarization abnormalities such as ST depression and T-wave inversions.

What is the significance of an early systolic murmur in a 26-year-old pregnant woman?

The early systolic murmur in a pregnant woman is described as a flow murmur, which is caused by increased blood volume and lower blood viscosity in pregnancy, resulting in turbulent flow through a normal valve.

How does the shape of a murmur help in identifying its cause?

The shape of a murmur, such as crescendo-decrescendo, can indicate certain conditions like aortic stenosis or aortic regurgitation. The specific timing and characteristics of the murmur help differentiate these conditions.

What is a flow murmur, and how does it differ from other types of murmurs?

A flow murmur is caused by turbulent blood flow through a normal valve, often due to increased blood volume or decreased blood viscosity. Unlike pathological murmurs, flow murmurs are typically not caused by structural heart defects.

What EKG finding suggests a right bundle branch block (RBBB)?

An incomplete right bundle branch block (RBBB) is suggested by a prolonged QRS duration (around 110-120 ms) with a specific pattern of R-wave taller than S-wave in V1 and a prominent S-wave in leads I and V6.

What role does the stethoscope’s diaphragm and bell play in auscultation?

The diaphragm is used to detect high-pitched sounds, while the bell is better for detecting low-pitched sounds. The bell is especially helpful for listening to murmurs or sounds like S4 that have a lower pitch.

What is the typical presentation of aortic stenosis, and how is it diagnosed?

Aortic stenosis typically presents with exertional chest pain, a harsh crescendo-decrescendo systolic murmur, and left ventricular hypertrophy (LVH) on EKG. Diagnosis is supported by these clinical and EKG findings.

How does scoliosis affect EKG readings, especially in tall patients?

Scoliosis can alter the chest wall anatomy, causing the heart to not align properly under the standard EKG leads. This can result in abnormal EKG readings, such as normal or low QRS amplitudes in leads V5 and V6.