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MODULE 15: THE HEART
PART 4 OF 7
On exam, Stina’s heart sounds were normal beneath the rub — the familiar ‘lub-dup’ of valves closing in sequence, the audible bookends of a single cardiac cycle.
Slide 1 Transcript
PATIENT CHART
STINA
THIS PART
Age 44
PRESENTING WITH
Chest Pain, mildly raised HR
TESTS ORDERED
Echcardiogram, ECG,
DIAGNOSIS
Acute pericarditis — not myocardial infarction or anxiety.
CHART CLUES
COLLECTED AS YOU GO
Sharp, Pleuritic, Positional Chest Pain With a Friction Rub
Structurally Normal Chambers and Valves on Echo
Diffuse, Concave ST Changes Across Nearly All Leads
Normal S1 and S2 With a Superimposed Friction Rub
A Steady, Un-Tetanizable Rhythm Throughout the Flare
An Inflamed Serous Sac — Friction Rub Plus Small Effusion
Recurrent Pericarditis as FMF Serositis Reaching the Heart
Put your money down: Her heart sounds are normal — so what is the extra scratchy noise riding on top of them?
Beneath the rub, Stina’s lub-dub was clean, steady, and on time — the valves closing exactly when they should. Before the videos, predict what kind of sound can lay itself over a perfectly normal cardiac cycle without being a valve problem at all.
Pick the answer you believe now. We’ll come back to it later!
A Clean Lub-Dub
Listening past the scratchy rub, the physician noted that Stina’s underlying heart sounds were normal: a clean ‘lub-dup,’ steady and unhurried. The rub was an extra noise laid over a well-timed cycle, not a sign the valves themselves were failing. Knowing the pump was mechanically sound let the team focus on the inflamed sac rather than chasing a valve problem that wasn’t there.
Systole and Diastole
Squeeze, then relax — the two-beat rhythm of it.
Slide 2 Transcript
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Single Choice: Which statement about systole and Diastole is correct?
Filling to 120 Milliliters
Diastole loads the ventricle — with a final top-off.
Slide 3 Transcript
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Drag the Words: Match each term to its role in filling to 120 Milliliters.
Volumes, Pressures, and Sounds
One heartbeat is a tightly choreographed alternation of contraction (systole) and relaxation (diastole). During diastole the chambers relax and fill; the atria then give a final top-off squeeze. When the ventricles contract (systole), rising pressureThe force exerted by gases in the respiratory system, affecting airflow and gas exchange. slams the atrioventricular valves shut — that closure is the first heart sound, ‘lub’ (S1) — and once ventricular pressure exceeds the pressure in the great arteriesBlood vessels that carry oxygenated blood away from the heart (except pulmonary arteries, which carr, the semilunar valves open and blood is ejected. As the ventricles relax, arterial pressure pushes back and snaps the semilunar valves closed — the second heart sound, ‘dup’ (S2). Every sound is a valve closing, and every closure is driven by a pressure gradient reversing. The cycle is the functional reason the chambers, valves, and wiring of the previous pages exist — and in pericarditis, the friction rub is simply an extra, abnormal sound riding along on this otherwise normal rhythm.
The Sealed Squeeze
All four valves shut, pressure rockets up.
Slide 4 Transcript
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Fill in the Blanks: Complete the key terms for the Sealed Squeeze.
Ejection: 70 Milliliters Out
The door gives, and most of the load leaves.
Slide 5 Transcript
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Mark the Words: Mark the words that describe ejection: 70 Milliliters Out.
An Extra Sound, a Normal Beat
For Stina, the numbers of a single heartbeat all came back normal — a ventricle filling to about 120 mL, ejecting about 70, a clean S1 and S2 marking systole and diastole right on schedule. The friction rub was an extra, abnormal sound riding on top of an otherwise flawless cycle, not a sign that the cycle itself was failing. Knowing the pump was mechanically sound — good volumes, good pressures, good timing — let her team stop chasing the engine and focus on the one thing adding noise to it: the inflamed sac.
Lub and Dub
Two sounds bookend one beat.
Slide 6 Transcript
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Multiple Choice: Choose the best answer about lub and Dub.
Pressure Runs the Show
Every valve event is a gradient reversing.
Slide 7 Transcript
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Sort the Paragraphs: Put the steps of pressure Runs the Show in the right order.
A Sound Out of Place
Stina’s rub rode along on a perfectly normal cycle.
Slide 7 Transcript
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Dialog Cards: Flip the cards to review A Sound Out of Place.
One Beat, Fully Told
Volumes in, pressures up, valves timed, blood out.
Slide 7 Transcript
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Summary: Pick the true statement about one Beat, Fully Told.
Output in One Equation
Two numbers multiply into five liters a minute.
Slide 7 Transcript
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Drag and Drop: Drag each label onto output in One Equation.
Your Whole Blood in a Minute
Roughly your entire volume, every minute, at rest.
Slide 7 Transcript
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Image Hotspots: Tap the labelled parts of your Whole Blood in a Minute.
Stroke Volume = 120 − 50
The leftover math from the last deck.
Slide 7 Transcript
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Single Choice: Which statement about stroke Volume = 120 − 50 is correct?
Ejection Fraction
The percentage that tells you how the pump is coping.
Slide 7 Transcript
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Drag the Words: Match each term to its role in ejection Fraction.
Preload: The Frank-Starling Law
Fill it more, and it pushes back harder.
Slide 7 Transcript
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Fill in the Blanks: Complete the key terms for preload: The Frank-Starling Law.
Contractility and Afterload
The other two dials on the pump.
Slide 7 Transcript
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Mark the Words: Mark the words that describe contractilityThe ability of muscle tissue to shorten with force. and Afterload.
Autonomic Control
The nervous systemThe organ system that controls body functions using electrical and chemical signals. works both levers at once.
Slide 7 Transcript
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Multiple Choice: Choose the best answer about autonomic Control.
The Pump’s Report Card
One equation, three dials, five liters a minute.
Slide 7 Transcript
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Sort the Paragraphs: Put the steps of the Pump’s Report Card in the right order.
FINDING!
Normal S1 and S2 With a Superimposed Friction Rub
The sign is a normal cycle with an extra noise: clean first and second heart sounds (AV valves closing for S1, semilunar valves for S2) marking a well-timed systole and diastole, with a scratchy to-and-fro friction rub laid over the top. The rub is not a murmur (turbulent flow through a bad valve) but grating serosa. Chart entry: mechanically normal cardiac cycle with a pericardial friction rub — an external sound, not a valve defect.
Confirm or refute your bet: Her heart sounds are normal — so what is the extra scratchy noise riding on top of them?
Stina’s ventricle filled to a normal ~120 mL and ejected a normal ~70, her S1 and S2 were clean and on time, and the scratchy sound over the top came from inflamed pericardial leaves grating with each beat — an abnormal sound riding on a normal beat.
Slide 7 Transcript
NEXT PART
Pressures and valves explain the cycle — but what lets millions of cellsThe basic structural and functional units of life. beat as one, and never lock up? The next page opens the cardiac muscle itself, and revisits an old thread: calcium.
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All Modules
- Anatomical Language, Membranes & Homeostasis
- Just Enough Chemistry
- The Cell & Its Transport
- Making Cells & Proteins
- The Integumentary System
- The Skeletal System
- The Muscular System
- Nervous Tissue & the Senses
- The Spinal Cord
- The Brain & the Blood–Brain Barrier
- The Autonomic Nervous System
- Special Senses (in developmentThe process of growth and differentiation.)
- The Endocrine System
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- Blood Vessels
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- Fluids, Electrolytes & Acid–Base Balance
- The Reproductive System
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List of terms
- pressure
- arteries
- contractility
- nervous system
- cells
- development