Speaking doctors

S3 is a sound heard after S2. Usually second heart sounds splits at pulmonary area (left second intercostal area). If you hear splitting sound at the apical area, its S3 sound. This sound is heard with the bell of the stethoscope. Make sure you do not press too hard with the bell, as in this case the bell will be turned into a diaphragm! The third heart sound is benign in youth, some trained athletes, and sometimes in pregnancy but if it re-emerges later in life it may signal cardiac problems like a failing left ventricle as in dilated congestive heart failure (CHF). S3 is thought to be caused by the oscillation of blood back and forth between the walls of the ventricles initiated by inrushing blood from the atria. Now that we have successfully learnt how to hear the third heart sound, I’ll leave you with this beautiful cup of flowers. Happy learning!

I’m given a consult in psychiatry ward. This patient is schizophrenic, is on olanzepine and the reason for consult is for cardiac side- effects of the drug. About two years back, when I was rotating in medicine in Dr Faisal Mehmood' s team, he 'd a patient to see there and asked us to come along if we were interested. Of course we joined him. We did not see any patients roaming about that day. Dr Faisal told us that this is the only ward in which smoking is allowed by patients. And now , two years later, I'm asked to see a patient there. It scares me a little, but I still go ahead. The entrance has two doors, one followed by the other, and you can only enter if you have the password, or the guard (who's inside) opens the door for you.I peep in , the guard notices me and opens the doors. Its a little weird inside. On the right there is a poster about what to do when you hear voices inside you!   Then there is the TV lounge, a play area, two tables on which a patient and...