HOCM = Hypertrophic cardiomyopathy; TR = tricuspid regurgitation; VSD = ventricular septal defect
Aortic stenosis: presents with a mid systolic ejection murmur that begins after S1 and ends before S2. Described as crescendo-decrescendo murmur. As a general rule, the more severe the obstruction, the louder and later-peaking the murmur. The murmur is classically heard loudest over the right 2nd intercostal space, with radiation into the carotid arteries.
Pulmonary stenosis: similar to aortic stenosis, it has a mid-systolic murmur, but is best heard over the second left intercostal space. *
HOCM: similar to AS, HOCM presents with a murmur secondary to obstruction and increased pressure gradient from the left ventricle to the aorta. However, unlike AS, the murmur is best heard between the lower left sternal border and the apex and maneuvers that decrease LV preload (Valsalva), will cause the murmur to intensify, whilst maneuvers that increase LV preload (passive leg raise, squatting), will cause the murmur to soften. *
Mitral regurgitation: chronic MR presents with a holosystolic murmur loudest over the apex. It reflects the wide pressure difference between the left ventricular and left atrium, such that the pressures in the left ventricle are greater than that of the left atrium throughout all of systole (pansystolic). The intensity of the murmur increases with maneuvers that increase LV afterload, such as sustained hand grip.
VSD: also presents with a holosystolic murmur, loudest at the mid-left sternal border.
TR is associated with a holosystolic murmur, but loudest at the lower left sternal border. The murmur is louder with inspiration (in contrast to MR) because there is increased blood flow in the R side of the heart during inspiration. *
MVP: mid-to-late systolic murmur, sometimes preceded by a click. The click represents the opening of the mitral valve as it prolapses, which is then followed by regurgitant blood flow from the left ventricle to the left atrium causing a systolic murmur. Similar to HOCM, the murmur is louder during Valsalva and softer with increased LV filling (such as expiration)
Let the greatness, achievements and lives of others inspire you, reflect over their mistakes and ponder over their successes, but remember the aim is to create your own legacy! Thinking without doing leads to nothing but a wasted life.
1 1723 minutes ago
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Last Friday October 12, 2018 marked the Inaugural Women Pharmacist Day! While women made up only 8% of all US pharmacists as recently as the 1960s, women currently comprise 55% of the pharmacist workforce!! Big Shout Out to all in our Profession!! Tag your favorite current or future female pharmacist 👇🏾🙅🏿♀️🙅♀️🙅🏻♀️🙅🏽♀️🙅🏾♀️💊💊💊💊
#Doctors say eating a well-balanced #diet is the best way to get the nutrients your #body needs.
People who think they may need a little extra help often reach for food #supplements.
These are diet aids, such as #vitamins, herbal extracts and fish oil.
But before you rush out for a supplement or eliminate #foods, it’s important to know that it’s only worth popping a #pill or cutting out food groups if that’s the actual root of the problem. Poor nutrition is not the only cause of #disease. Play it #safe and get everything checked by your doctor before making dietary #changes or taking a supplement.
“I suck at cooking”
Keep it simple
For the last couple of weeks, this was my lunch along with a bowl of Basmati Rice 🍛
How did I feel after eating out?
Was it hard to cook?
✅Almost as easy as boiling water
Did it meet all of my nutrition needs?
✅You bet your 🍑 it did
Please don’t buy into the world of Instagram that makes all of this so much harder than it needs to be, keep it simple and keep yourself healthy!
I pretty much spent the majority of my day doing chronic illness admin, (it is a full time job!)
In August I had one of my happiest days in months, I found out my GP was putting in place a referral at Stanmore Hospital for the three week EDS rehabilation stay... I was over the moon as I had been told this had been done months prior and later found out their had been a mix up in my GP surgery..
I found out today after chasing that they did not respond to anyone involved in my care, and what is now entails so much further conversations with doctors and their colleagues: not to mention that it is impossible it will start before this side of the new year...
It’s so beyond frustrating when you research every treatment, hospital, doctor out there to get the best management of your chronic illnesses and for some reason or another it’s delayed (we are now talking at least a year on from my first referral)... and people wonder why your symptoms are no better or deteriorating after six months?-This is the truth of it.
I cried, face palmed, and then headed down to the gym this evening for a light swim and sauna session. •
I’ve realised lately that hate is wasted -often things are simply not worth stressing over. The time, energy and frown lines (hello!)
Until Monday I can’t do anything, I have to be positive, and let the anger wash away. It’s simply not going to make the situation any easier to fix, yes it’s my health but stress also doesn’t help flares. Let’s be kinder to our minds and bodies 💕
Have you gotten your flu shot? An annual seasonal flu vaccine is the best way to help protect against influenza (the Flu). Influenza is a potentially very serious disease which may lead to hospitalization and even death. millions of people are infected with influenza annually and many die from flu related complications. Influenza strains change every season usually requiring a specific vaccine for that season vaccination has been shown to have benefits that include reducing the risk or the severity of a flu illness, hospitalizations, and the risk of flu related death. those most at risk are children and elderly individuals - Advisory Committee on Immunization Practices recommends with rare exception, vaccination for everyone six months and older. For many there is an option of nasal spray flu vaccine which is approved for people two years through 49 years of age you must be healthy and nonpregnant. when you immunize against influenza you not only protect yourself but indirectly protect those with whom you may contact like family members, coworkers, individuals gathering in public places and others. For more information check out the link in our bio.
Man suffers from rare congenital giant pigmented nevus, commonly know as giant furred moles.
Initially he only had black birthmarks but from the age of eight these started to grow thick black hair.
The congenital melanocytic nevus is a type of nevus (or mole) found in infants at birth. This type of birthmark occurs in an estimated 1% of infants worldwide. As compared with a melanocytic nevus, congenital melanocytic nevi are usually larger in diameter and may have excess terminal hair, a condition called hypertrichosis.
Melanocytic Nevi often grow proportionally to the body size as the child matures. As they mature, they often develop thickness, and become elevated, although these features can also be present from birth. Prominent terminal hairs often form, especially after puberty. With maturity, the nevus can have variation in color, and the surface might be textured with proliferative growths.
Large and especially giant congenital nevi are at higher risk for malignancy degeneration into melanoma. Because of the premalignant potential, it is an acceptable clinical practice to remove congenital nevi electively in all patients and relieve the nevocytic overload.
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18 139719 hours ago
Internal Medicine inpatient done! I will not miss waking up at 5:30 AM to round 😭 This month, we worked in the ICU, the ED, and main floors. I learned so much on how to manage critically ill & long-term patients. As much as I enjoyed learning & the long-term patient-physician relationship (my patients even remembered my name! 😭 and for those who did not, always referred to me as “the one who was always happy” 🤪💀) I still miss the OR 😭 Hoping to use this weekend for rest & recovery before starting Outpatient IM next week ❤️
7 12675 hours ago
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