Heart Sounds And Pulse, Abnormalities; Physiology Y2B2.pptx
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The document discusses normal and abnormal heart sounds and pulses. It describes the four main heart sounds (S1, S2, S3, S4) and their causes. S3 often indicates heart failure while S4 suggests hypertension. Abnormal heart sounds may also be linked to conditions like mitral stenosis. Common pulse abnormalities are also outlined, such as tachycardia, bradycardia, and irregular rhythms. Specific abnormal pulse types like waterhammer, anacrotic, pulsue alternance and paradoxus are each described as indicators of particular cardiac issues.
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Heart sounds are produced by the closing of heart valves. The first heart sound (lub) is caused by closure of the atrioventricular valves starting systole, and the second sound (dub) is caused by closure of the semilunar valves ending systole. Four heart sounds are clinically important - S1 and S2 are normal systolic sounds, while S3 and S4 may indicate pathology when heard in adults. Heart sounds are auscultated and can be recorded as phonocardiograms to analyze the timing and intensity of the sounds.
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references:
macleod's clinical examination 13th edition
hutchinson clinical methods
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The document defines and describes the arterial pulse wave pattern and examination of arterial pulses. It provides details on:
- The components of the pulse wave during systole and diastole.
- How the pulse wave changes as it travels through the arteries.
- Abnormal pulse characteristics including slow rising, collapsing, twice beating, dicrotic, and paradoxical pulses.
- The technique for examining pulses at different anatomical locations and documenting findings.
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- S3 is an early diastolic sound caused by the rapid filling of blood into the ventricles. It can be physiological in children/young adults but usually indicates ventricular dysfunction or overload in adults over 40.
- S4 is a presystolic sound caused by atrial contraction against closed valves. It indicates left or right ventricular dysfunction.
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2. Specific physical findings are described for different cardiovascular conditions like heart failure, infective endocarditis, hyperlipidemia, and valvular abnormalities.
3. Examination techniques and how to assess different components of the cardiovascular exam like pulse, jugular venous pressure, and heart sounds are outlined.
Cardiac Arrhythmias
This document discusses different types of arrhythmia including normotopic arrhythmia like sinus arrhythmia, sinus tachycardia, and sinus bradycardia. It also discusses ectopic arrhythmia which occurs when structures other than the SA node act as the pacemaker, leading to conditions like heart block, extrasystole, paroxysmal tachycardia, atrial flutter, atrial fibrillation, and ventricular fibrillation. Abnormal pacemakers can also develop from the AV node, atrial musculature, or ventricular musculature. Current of injury affects the ECG pattern through axis deviation when parts of the ventricle are affected.
heart auscultation
The document discusses auscultation of the cardiovascular system. It describes the normal heart sounds S1 and S2 and factors that can influence their intensity. Extra heart sounds S3 and S4 that indicate pathology are described. Points for auscultating murmurs are provided, including describing timing, location, radiation, duration, intensity, pitch and quality. Systolic and diastolic murmurs and their differentials are briefly discussed.
Cardiovascular system.ppsx
The cardiovascular system consists of the circulatory system (heart and blood vessels) and lymphatic system (lymph nodes and vessels). The heart pumps oxygenated blood into the systemic circulation and deoxygenated blood into the pulmonary circulation. It has four chambers and uses electrical signals and mechanical contractions to circulate blood continuously. The cardiac cycle involves atrial and ventricular systole (contraction) and diastole (relaxation). Cardiac output is determined by stroke volume and heart rate. Venous return, arterial pressure, blood volume, respiration, and skeletal muscle pumps influence blood flow.
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Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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- 1. Abnormal Heart Sounds & Abnormal Heart Pulse SECTION 1 GROUP 3
- 2. Introduction: Heart sounds are the noises generated by the beating heart and the resultant flow of blood through it. It is normally heard using a stethoscope. Phonocardiogram is a device that magnifies the sounds from the stethoscope. Flow of blood can also be pulsated from arteries by hand.
- 3. Common auscultatory areas on the chest:
- 4. Primary Heart Sounds: The first heart sound is produced by the closure of the AV (mitral & tricuspid) valves. The second heart sound is produced by the closure of the semilunar (aortic & pulmonary) valves.
- 6. Extra Heart Sounds: The third heart sound occurs at the beginning of diastole after S2 and is lower in pitch than S1 or S2 as it is not of valvular origin. 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 (e.g. Failing left ventricle).
- 7. Extra Heart Sounds: (cont.) The fourth heart sound, AKA atrial gallop occurs just before S1 when the atria contract to force blood into the LV. If the LV is noncompliant, and atrial contraction forces blood through the atrioventricular valves, a S4 is produced by the blood striking the LV.
- 8. Abnormalities in Heart Sounds: - S1 (e.g., mitral stenosis, atrial fibrillation) - S2 (e.g., hypertension, aortic stenosis) - S3 (e.g., congestive heart failure) - S4 (e.g., hypertension)
- 9. Arterial Pulse: Arteria pulse (AP) represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed near the surface of the body AP is evaluated by: rate, rhythm, volume and character.
- 11. Abnormalities of AP: 1) Tachycardia (HR is more than 100. could be sinus or arrhythmic. It also includes: - Atrial flutter - Atrial fibrillation 2) Bradycardia (HR is less than 60. could be sinus or arrhythmic.
- 12. 3) Irregular rhythm: Can be either: -Regularly irregular e.g. 2nd degree AV block. -Irregularly irregular e.g. AF.
- 13. 4)
- 14. 5) Waterhammer pulse: It indicates: Aortic stenosis
- 15. 6) Anacrotic pulse: It indicates: Severe aortic stenosis
- 17. 8) Pulsus bisferiens: It indicates: Aortic regurgitation
- 18. 9) Pulsus paradoxus: It occurs in: Cardiac tamponade Or Pericardial effusion