A 72-year-old male with past medical history of diastolic co…

A 72-year-old male with past medical history of diastolic congestive heart failure and hypertension presents for routine follow-up. On auscultation for the cardiac physical examination, you note regular rate and rhythm with S4 heart sound. No murmurs, gallops or rubs are appreciated. What does the S4 sound likely represent?

A patient is being evaluated for surgery. The therapist hear…

A patient is being evaluated for surgery. The therapist hears rales in the lung bases and notes prominent swelling of the ankles. She presses a finger into the edema and notices that a depression remains when she lifts her finger away. The depression is clearly visible for slightly more than 1 min. This would be classified as pitting edema: