Tiddy-Bum

Hey Daniel,

Now you're crossing union lines. That is Evan's and My Department!!! (I'm Family Practice).

Seriously, what you hear are the various valve closing, atrial and ventricular. The split that you hear is due to valve on the lung side of the heart closing at a slightly different time than the valve on the systemic, body side. This is NORMAL. If you listen closely you will notice a widening and narrowing of that split as you breath in and out. The change in the width of the split is due to the changing intrathoracic pressures within you chest (Breathing in causes a drop, out causes an increase) which affects how much blood is returned to you heart.

That is the short explaination.

Jon

P.S. Ever wonder why doctors' handwriting is so bad. It's not because we're so rushed (popular theory). It's because we CAN"T SPELL!!! (especially those big doctor words. :mrgreen:

 

Naa it's all those years of taking notes.

 

Nah, most med. school classes set up a note taking service. Rotate the note taking responsibilities between class members and paying a fee for xeroxing those notes.

Another theory is that there exists a core curriculum course in med school in bad penmenship. I swear, it's because we CANT SPELL.

 

man, I never hear anything like that... but I guess I'm just not in tune... will get that way in the NEXT life... about 14 years ago a couple of days before Halloween.. I had this great chest pain it was on a Saturday night, bad enough that I took myself to the doctor on Monday... his office was on the second floor and I took the elevator... remembering that I had some jokes in my car ran down and back... the doctor listened to my heart and said he thought there might be an angina.. so set up a tread mill for Wednesday... Tuesday was Halloween, and as I gave a candy to a kid of course I had one for myself.. about 2 am I had that chest pain again and about 3, my wife asked if I thought I had groaned enough to warrant calling the doctor.. by about 4 I was at the hospital and by 6 was on my way to getting the zipper and a 3 way by-pass... I know I am a doctor's nightmare....sorry......honest today I don't hear tiddy-bum

Bob

 

Just be glad you hear something. :wink:

 

By that theory, my wife must be the dean of Harvard Neurosurgery. She is a spelling champion, but often can’t decipher her own chicken scratch! Funny thing is, recently her aunt wrote her a letter that looked exactly like her own handwriting, and she couldn’t read it! It must be a genetic flaw.

 

The split I was talking about earlier is the one between the two halves ofyour Tiddy. The split between the Tiddy and the Bum is: Tiddy are the valves between the atria (I often refer to them as the priming pumps) and the ventricles. The Bum is the closing of the big valves (primarily the aortic, because of the relative pressures involved and the wiring that synchonizes the ventricular contractions of the left and right heard, the tricupid valve is usually masked by the aortic valve closing) between the heart and the circulatory system. The contractions themselves don't make much noise. Think of it like squeezing a closed water balloon. (If the neck of the balloon is open, you would hear a continous rough sound, in the heart that would be equal to a heart murmur with the rough, turbulent blood flow past a stiff or damaged valve) .

Lots of other heart sounds too. But if I told all our arcane secrets to you, I'd have to either accept you into the cult or kill you.

 

Daniel,

Q: Do you know what the difference between doctors and God is?

A: God knows that he is not a doctor!!!

Jon

 

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Hahaha... great one Jon... am on my way to see the 'Back Quack', this should get an extra adjustment.. or something...

Bob

 

As long as it is generally regular with occasional skipped or extra beats (doc term "regularly irregular"), it is NOT atrial fibrillation. If there is no rhyme or reason to the heart beat pattern ("irregularly, irregular") then it is atrial fibrilllation. Sometimes just as easy to tell by checking your pulse pattern. That way you don't have to deal with all the other stuff.

Hope you take one aspirin a day (assuming you are not on some other "blood thinner" (I hate that term because the blood is not actually thinned, no change in viscosity, just doesn't want to clot as fast... But now that is the start of one of my soap box lectures. (Actually, went to college to be an Aeronautical Engineer. ended up a doc instead))

 

Interesting discussion...

I'm a 27 year old computer geek, kinda overweight, not quite enough exercise...

I started noticing strange things about my heartbeat, and it worried me. I thought I noticed occasional irregular beats and whatnot. Once while sitting at my desk I felt a little dizzy, and noticed my heart was beating faster than it should have been.

Well, I'm a bank employee, and I have pretty decent medical insurance, but I'm also a university student and am finishing up my last semester of my computer science degree. I decided to be cheap and go see a doctor at the student clinic. I talked to him about my observations -- he listened to me and didn't observe anything troubling, but based on what I told him I had observed he referred me to a cardiologist.

One week later... short one-page EKG shows nothing irregular at all, cardiologist listens to me and finds nothing unusual. Considering that everyone else in the waiting room was elderly, and I was asked if I had brought a list of my medications (I don't take any)...I imagine I was wasting everybody's time.

I'll have to wait and see what my copay is for that cardiologist visit. I imagine specialist doctors are very expensive...

One question the cardiologist never really answered was: given that I'm nontechnical when it comes to medicine, and can't really trust my own observations... at what point should I worry that something's wrong? What "layman" observations should I wait for before it's not a waste of time to call a doctor? WebMD's web site is (understandably) generous with warning and caution, so I wonder if someone here has more practical, less paranoid advice.

I imagine one good rule of thumb is: if I feel pain, not a little discomfort or pressure but pain, get to a hospital NOW.

Is that about right? Are there any other things I should watch for?

--Michael Spencer

 

Never listened to my heart through a stethoscope. I'll put that on my " to do" list. But I have something called " Wolff-Parkinson-White Syndrome" a congenital thing where the heart has an extra electrical connection going on, so that it sometimes has extra beat. Rather than the "ba-bum, ba-bum" that I feel (without the accuracy of a stethoscope, mind you), it will sometimes go " ba-ba-ba-dum" or somthing. I never had any symptoms until about 6 years ago, and they only lasted a month or so, but that's when I got the diagnosis.

During the same time period, I was watching Chicago Hope, and guest star Robert CUlp had WPP and had to be operated on " RIGHT AWAY" or he could die " ANY MINUTE" . And soon after that, ER had Noah Wyle's character talk about a patient who was at risk bec ause of WPW. (I had a stress test, and my WPW is not a problem, as the extra beat goes away when my heart rate gets up).

Back to stethoscopes: have you experimented with it? Try listening to your gut to see if you can hear the peristaltic movement. Any other body parts you want to listen to are up to you! (If you live in an appartment, or stay in hotels, it would make a good substitute for a glass held up to the wall :wink: )

 

Daniel... you read that right... but it can also be a pain in the jaw... or back... and of course the left arm...

I do the asprin a day thing, but when I run into things I get black and blues quickly... I don't notice that I bleed more...

Bob

 

Yep,
I currently work as a 0.9 FTE (9/10 of full time) meaning that I only see pts. in the office 4 days a week. Of course there is still the hospital rounds every morning, call every 4th, and I still do OB (as a family doc) and in 12 years have only missed 4 deliveries, virtually all when I was out of town. And then there is the paperwork of course. End result 80-85 hours a week is typical. :goodmorning: Just wonder how I did it when I was full time.

Would I do it again? Yup, but I would demand a flamethrower for all the paperwork. :flame: :flame: