Glossary

Ankylosing Spondylitis: Genetically based disease (HLA B27 antigen positive) characterized by fusion of the vertebral bodies ("bamboo spine") joint inflammation and dilatation of the aortic root.

Asthma - disease of the respiratory system that involves inflammation of the bronchial tubes which causes cough, wheeze, dyspnea and varying degrees of reversible airflow obstruction. This inflammatory disorder, typically due to an allergic reaction causes the airways to narrow, leading to difficulty breathing.

Atrial myxoma: Benign tumor of the atrium often causing valvular obstruction or embolic phenomenon.

Bioprosthetic valve: Artificial valve constructed from biological tissue.

Bronchial Sounds (same as tracheal sounds) - heard on the chest at sites which are close to large airways. In contrast to vesicular sounds, they are relatively louder in expiration than inspiration. They have a tubular or hollow quality similar to air being blown through a tube.

Bronchiectasis – This disorder is characterized by abnormal destruction and dilation of bronchi or bronchioles. It can be caused by a chronic inflammatory or degenerative condition of one or more bronchi or bronchioles marked by dilatation and loss of elasticity of the wall. It is commonly associated with chronic, productive cough.

Carcinoid Heart Disease: Thickening of the heart valves (right sided more commonly) often with marked regurgitation associated with a metastatic carcinoid tumor. (Carcinoid is of a chromaffin cell origin, usually originating in the small bowel).

Cardiomegaly - type of progressive heart disease in which the heart is abnormally enlarged, thickened and stiffened. As a result, the heart ability to pump blood is weakened, often causing heart failure and the backup of blood into the lungs.

CHF (congestive heart failure) - heart failure in which the heart is unable to maintain an adequate circulation of blood in the tissues of the body or to pump out the blood returned to it by the venous circulation.

Chordae Tendinae: A thin supporting structure of the atrioventricular valves connecting the leaflets to the papillary muscles.

Chronic Bronchitis - The American Thoracic Society defines chronic bronchitis "as a clinical disorder characterized by excessive mucus secretions manifested by chronic or productive cough. On most days for a minimum of 3 months of the year and for not less than two successive years." Unfortunately, other disorders with similar manifestations must be excluded, such as bronchiectasis, tuberculosis, and lung abscess. Patients with predominant asthma or emphysema may fit this distinction. Many patients with pathological or physiological hallmarks or chronic bronchitis may not qualify under this definition; that is, they do not cough.

Coarse Crackles (also known as coarse rales) - intermittent explosive sounds that have been described as being similar to the crackling sound heard as wood burns. On auscultation coarse crackles are in general lower pitched (less than 400Hz), less intense and of longer duration than fine crackles.

COPD (Chronic obstructive pulmonary disease) - a condition in which there is a fixed and progressive obstruction to air flow. COPD is a designated label for a group of lung diseases. The two diseases that generally are associated with COPD are Chronic Bronchitis and Emphysema.
Chronic obstructive pulmonary disease (COPD) refers to a group of disorders that have in common persistent airflow obstruction. Pathologically, chronic bronchitis and emphysema are distinct, bronchitis being limited to the airways and emphysema to the pulmonary parenchyma. From a clinical point of view, the distinction between bronchitis and emphysema is difficult. Both processes may be present in the same patient and both are characterized by expiratory flow obstruction. Furthermore, the patients with both processes often present with the same symptom; namely, dyspnea on exertion. Both may have airway hyperreactivity. The situation is further complicated by the fact that patients with either disease may have the airway hyperreactivity as is seen in asthma. Consequently, lumping these conditions into this single label, COPD, is useful.

Crackle Family – crackles, which are explosive sounds associated with an airway opening, can be often detected by multiple microphones on the chest. We assume that crackles occurring within 5ms likely represent the same event of airway opening and call them a crackle family. The crackle with highest deflection we call the mother crackle and the corresponding deflections at other channels we term daughter crackles. As a rule of thumb crackles in patients with CHF and Pn are transmitted over an area about the size of the palm.

Crackle Rate - this is defined as the number of crackles per breath or the number of crackles per second. Normal person may have up to two crackles per breath. Very high crackle rates are found in interstial fibrosis.

Ebstein’s Anomaly: Congenital anomaly characterized by inferior displacement of the tricuspid valve resulting in a small “true” right ventricle inferior to the tricuspid valve and an “atrialized” component of the right ventricle along with the true right atrium superior to the valve.

Eisenmenger's Physiology: Reversal of flow through a cardiac defect from L to R to R to L because of an increase in right sided pressures secondary to marked pulmonary hypertension. Pulmonary hypertension, in turn, is due to increased peripheral pulmonary vascular impedance.

Emphysema - The American Thoracic Society defines emphysema as an anatomical alteration of the lung characterized by an abnormal enlargement of the air spaces distal to the nonrespiratory bronchioles accompanied by destructive changes of the alveolar walls.

Endocarditis: Inflammation of the valvular leaflets often secondary to a bacterial infection. Non infectious causes are less common such as lupus.

FEV1 - forced expiratory volume is the amount of air that the patient can exhale in one second.

Fine Crackles (also known as fine rales) - intermittent explosive sounds that have been described as being similar to the crackling sound heard as wood burns. On auscultation fine crackles are in general higher pitched (over 400Hz), less intense and of shorter duration than coarse crackles.

First degree AV block: Prolongation of conduction time through the atria or through the AV node manifesting as a prolonged P-R interval on the surface electrocardiogram.

FVC - forced vital capacity is the total amount of air that the patient can exhale after a deep inspiration.

Gallavardin Phenomenon: Radiation of the aortic stenosis murmur to the apex (most commonly seen in the elderly).

Hepatojugular Reflux – an increased pressure on the liver causes an increased cervicle venous pressure.

Hepatomegaly - enlarged liver; common in right heart failure patients.

Homograft: Artificial valve consisting of a transplanted biological valve from the same species as the recipient.

Jugular Venous Distention - seen as a bulging neck vein when the right ventricle fails to pump blood through pulmonary circulation, which in turn backs up into the vein.

Lupus: Collagen vascular disease associated with autoantibodies to various organs. May be associated with the formation of non-infectious endocarditis.

Marfan’s syndrome: Syndrome characterized by a connective tissue defect resulting in a tendency towards aortic dissection and or expansion of the proximal aorta; is associated with mitral valve prolapse hyperextendable joints and lens dislocation. Patients are usually tall and thin with summation of the length from fingertip to fingertip of each arm when extended laterally exceeding or equaling their height.

Mucopolysaccharidosis: Deposition of abnormal fat and protein within the cardiac valve leaflets.

Noonan’s Syndrome: Characterized by impaired mental abilities, abnormal facies, hypertrophic cardiomyopathy, pulmonary or infundibular stenosis, peripheral pulmonary artery stenosis, patent ductus arteriosus, atrial septal defect and tetralogy of Fallot.

Opening Snap: High pitched presystolic sound associated with opening of a stiff atrioventricular valve.

Paradoxical Splitting of the second heart sound: In its milder form paradoxical splitting of the S2 is associated with narrowing of S2 split with inspiration. In the advanced form P2 of the second heart sound can appear before A2 (often due to prolonged flow through the aortic valve causing a delay in closure.

Peripheral Pitting Edema – swelling of the dependent body part, usually the ankles and feet. Common caused by chronic right heart failure where venous blood backs up which increases the pressure gradient causing leakage of fluid into the interstitial space.

Phen-fen: Weight loss drug associated with valvular abnormalities and/or pulmonary hypertension no longer available on the market.

Pleural Rub – this sound has a leathery quality. It has been compared to the sound made when two pieces of leather are rubbed together. It is believed to be caused by the surfaces of the pleura rubbing together. Normally these surfaces slide silently over each other. When they are inflamed the rubbing noise is made.

Pneumonia – inflammation of the lung parenchyma that is usually caused by a microbial agent. In many cases, the term is modified to indicate a specific clinical setting, such as community-acquired pneumonia, nursing home pneumonia, pneumonia in the immunocompromised host, and aspiration pneumonia, among others. These terms are important because of differences in likely microbial agents, prognosis, and diagnostic evaluation. Other classifications are based on the tempo of the disease, such as acute, subacute, or chronic pneumonia. Classification may also be based on observations with radiographs or scans to characterize the changes as lobar pneumonia, bronchopneumonia, interstitial pneumonia, or lung abscess and accompanying findings, such as hilar adenopathy, pleural fluid, or atelectasis.

Pneumothorax – a state in which air or other gas is present in the pleural cavity and which occurs spontaneously as a result of disease of the lung or puncture of the chest wall or is induced as a therapeutic measure (as in the treatment of tuberculosis).

Pulmonary Vascular Impedance: The resistance to flow existing within the blood vessels leading into or within the lung parenchyma.

Rhonchi (also known as sonorous rhonchi) - also described as "continuous" sounds. They are lower in pitch than wheezes and have a snoring quality. The frequency is less than 200Hz.

S3 or S4 Gallop Rhythm - gallops are low frequency sounds that are associated with diastolic filling. The gallop associated with early diastolic filling is the S3 and may be heard pathologically in such states as volume overload and left ventricular systolic dysfunction. The S4 is a late diastolic sound and may be heard in such pathologic states as uncontrolled hypertension.

Sarcoidosis - disorder characterized by abnormal formation of inflammatory masses or nodules (granulomas). Granulomas consist of certain granular white blood cells (modified macrophages or epithelioid cells). Granuloma formation most commonly affects the lungs, but can also affect upper respiratory system, lymph nodes, skin, and eyes. The cause of sarcoidosis is not known.

Squawks - short, inspiratory wheeze-like sounds that have been described in pneumonia, hypersensitivity pneumonitis, and other fibrotic disorders. Squawk duration is usually longer than 20ms and shorter than 100ms. The frequency is usually higher than 400Hz.

Stridor - characteristic feature of upper airway obstruction. Stridor is a continuous, high pitched sound heard on auscultation, with or without a stethoscope, that is loudest over the mouth, neck, and upper trachea. The principal feature that distinguishes stridor from wheezing is that stridor is predominantly inspiratory.

Syphilis: Spirochete based sexually transmitted disease which may be associated with inflammation, expansion and or dissection of the proximal aorta.

Tachycardia - fast heartbeat, greater than 100 beats per minute in adults.

Tetralogy of Fallot: Congenital heart abnormality characterized by 1) Pulmonary outflow tract obstruction such as pulmonic stenosis, 2) Ventricular septal defect, 3) Overriding aorta, 4) Right ventricular hypertrophy.

Time Amplitude Plot - displays the waveform of sound. It is similar to a phonocardiogram. The amplitude is plotted on the y axis; time on the x axis. This may be done in real time or in the time expanded mode. The latter, by expanding the x axis allows details of the waveform, such as the shape of crackles, to be more readily seen.

TLC – total lung capacity is the maximum amount of air the lungs can hold when fully inflated.

Tuberculosis - pulmonary tuberculosis is a parenchymal lung disease caused by Mycobacterium tuberculosis, slow-growing mycobacteria that thrive in areas of the body rich in blood and oxygen.

Unrelated Crackles – crackles that belong to different crackle families.

Valsalva: Physiologic maneuver in which intraabdominal pressure is increased (usually by bearing down against a closed glottis) resulting in initial inhibition of right ventricular blood return followed by a rapid increase in return once abdominal pressure is released.

Vesicular Sounds - heard at sites that are at a distance from large airways. The vesicular sound is a soft sound that has been compared to that of wind blowing through trees. It is louder in inspiration than expiration.

Wheezes (also known as sibilant rhonchi) - described as relatively "continuous" sounds as compared to crackles. They occur more often in expiration. They usually last for more than 200 milliseconds and have a musical quality. The frequency is greater than 200Hz.

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