Skills lab - Pathological heart sounds

yo!! long time no see you, blog!

anyway, nk post pasal something yg MEDICibberish....
ok, psl bunyi jantung N + pathologic.

First, the positions of stethoscope we're gonna put on the chest.
We have 7 positions.

1. Second right intercostal space
2. Lower left sternum
3. Second left intercostal space
4. Third left intercostal space
5. Fourth left intercostal space
6. Apex
7. Medial of pulmonal valve

(It's the blue dots)




Tips for my exam tomorrow? xD
Frequent place of pathological heart beats.
1, 3, 2, 6

Sounds, place and diseases

• Systolic murmur | 1,3,4,5 | Aortic stenosis  
• Systolic murmur | 3, 7 | Pulmonal stenosis 
• Diastolic murmur (with opening snap) | 6 | Mitral stenosis 
• Holosystolic | 2, 6 | Tricuspid, Mitral Insufficiency (but the one i heard has no 'dup' sound in it)
• Midsystolic | 2, 6 | Mitral Insufficiency
• Gallop | 2, 6 | Decompensatio cordis
• Holosystolic | 4,5 | Ventricular septal defect (VSD)

Anyway, just first listen to position 1 first, if it's abnormal, listen to 3 --> it could means Systolic murmur AS (the only one that abnormality is at position 1.

If 1 is normal, go straight to position 2, if it's hard to listen at # 2, go to #6. There's too many abnormality that can be at position 2, 6 --> Holosystolic, midsystolic, gallop.

If #2 is normal, and # 6 is abnormal --> only diastolic murmur (with opening snap) It sound like a rushing sounds. The end of the first heart beat kinda overlaps with the second heart beat.

Then if 1, 3, 2, 6 are normal, listen to 4, 5, abnormality at 4, 5 --> holosystolic murmur of VSD

Anyway, we should be able to distinguish the sounds. My doctors said NOT to remember just the position of the heart sounds. But this way, I think I could make it simple since the exam time is pretty short like 1 mins only.

The tricky part is how to distinguish the sounds of systolic murmur AS and midsystolic murmur. If it's me, I'll say that midsystolic sounds if heavier than systolic murmur and like holosystolic murmur with "dub".
If systolic murmur AS - krrrrteb (it sounds crispy)
If midsystolic murmur - grrrrdub (it sounds heavy and bold)

For systolic murmur PS and holosystolic murmur.
They both sounds like a wind. If I were to say, I heard that systolic murmur sounds like a heavy wind and holosystolic sounds like a wind in the desert? It has no gap between murmur and heart sounds while systolic PS kinda stop after the heart sound before the murmur starts again.

For holosystolic MI/TI and holosystolic VSD
All I can say is that it's slower in pace and heavier than the holosystolic MI/TI. Sounds more like a dying heart, slow and waiting for death.

Sorry if I'm wrong cuz that's what I heard from my skills lab.
Just wanna do well in my exam. >_<