HOW TO Dx HEART PROBLEM

Pre-clinical Preparation

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 • Reliable
• Bring energy and enthusiasm
• Dress well
• Balance self-sufficiency with asking questions
• Participate
• Stay flexible
• Pay attention to detail
• Network
 Anamnesis
- Heart Failure
- CAD
- Arrhytmia
Heart Failure
Chest Pain : Coronary Artery Disease ?
Angina Pectoris
PF
Auscultation
 S2 Splitting

• S2 usually consists of a louder and earlier aortic valve closure sound (A 2), followed
by a later and quieter pulmonary valve closure sound (P 2).
• Normal physiologic splitting or variability is appreciated most easily in the
pulmonary area during or near the end of inspiration.
• During expiration, the aortic and pulmonary valves close almost synchronously and
produce a single or narrowly split S2.
• Normal splitting of S2 is caused by (1) increased right-sided heart filling during
inspiration because of increased blood volume returning via the venae cavae; and
(2) diminished left-sided heart filling because blood is retained within the small
blood vessels of the lungs when the thorax expands.
• During inspiration, when the right ventricle is filled more than the left, it takes
slightly longer to empty. This causes the noticeable inspiratory delay in P 2 in
relation to A2.
• Splitting of the S2 during inspiration is a normal finding and should be sought in all
patients.
Cyanotic Heart Disease
Cyanotic Heart Disease
ECG
 CONTOH

I rama sinus; QRS Rate: 88; Normoaxis; Gel.P normal; PR int 0,16;
QRS dur 0,08;QRS progression N ;Q patologis (-); ST-T changes (-)
Gelombang T N Kesimpulan: Normal Sinus Rythm
Irama sinus normal
 Take Home Messages

• You are responsible for treating patients under appropriate

supervision. They have to ensure that their functions are
carried in a good manner and more priority is given for the
patient' s safety.

• As a Co-Assistant, you'll have all of the experiences that a

doctor would have, but without as much responsibility.

• You won't be expected to make major decisions, but you

will more than likely get to watch how others make these
decisions.

• This will help you be prepared for an upcoming job where

mistakes are not easily forgiven.