Thread by @AndreMansoor

1/6
A young man is admitted to the hospital with malaise and fever. You examine his hands and find these tender nodules.

This should generate a hypothesis.

(Heart sounds in this thread best heard with headphones or a decent computer speaker)

2/6
With your hypothesis in mind, you listen to the patient's heart. You anticipate what you might hear.

"The ears can't hear what the mind doesn't know."

3/6
Based on the holosystolic murmur at the apex that you anticipated you would hear, you diagnose the patient with mitral valve endocarditis. Two days later, his heart sounds change. Take a listen.

An additional diagnosis has now been made.

4/6
Two days later, you know longer hear the pericardial friction rub. In fact, his heart sounds are difficult to hear at all. He develops hypotension and pre-syncope and his neck looks like this:

This should generate a hypothesis.

5/6
You confirm your hypothesis with a bedside maneuver (video features a different patient with the same diagnosis):

6/6
You have diagnosed infective endocarditis of the mitral valve with pericardial involvement, evolving to pericardial effusion with cardiac tamponade. All with your eyes and ears.

pdxpdx.com