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The document discusses the Valsalva maneuver and its use in diagnosing left ventricular dysfunction. It describes the normal 4 phase response to Valsalva and explains how those with left ventricular dysfunction have an abnormal "square wave sign" response where straining during the maneuver increases stroke volume and arterial pressure. Two figures are included, one showing the normal Valsalva response and another depicting the Frank-Starling curve in patients with left ventricular dysfunction.
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Approach to Murmur
This document provides information on assessing murmurs through auscultation of the heart. It discusses the major auscultatory sounds including heart sounds and murmurs. It describes the auscultation areas of the heart and classifications of murmurs by timing, intensity, pitch, and associated disorders. Maneuvers that can augment or reduce murmurs are presented. Investigations like echocardiography and treatments including medications and surgery are also summarized.
S3 and S4
This document discusses S3 and S4 heart sounds. S3 occurs near the end of rapid ventricular filling and is related to forces during active filling. It can be normal or indicate diastolic dysfunction. S4 follows left atrial systole and results from sudden tensing of the left ventricle. It requires a non-compliant left ventricle and indicates elevated left ventricular end-diastolic pressure. Both S3 and S4 can have physiological or pathological causes such as heart failure, hypertension, coronary artery disease and more.
Diastolic murmurs
This document discusses different types of diastolic murmurs, including their causes, characteristics, and clinical significance. There are two main types: diastolic regurgitant murmurs caused by retrograde flow across incompetent valves, and diastolic filling murmurs caused by forward flow across stenotic atrioventricular valves. Early diastolic murmurs include those from aortic and pulmonary regurgitation. Mid diastolic murmurs include those from mitral stenosis, caused by forward flow during the rapid ventricular filling phase. The characteristics of murmurs provide clues to differentiate types of structural heart disease.
Pulse tripleresponse
The document summarizes the arterial pulse, venous pulse, circulation time, and the triple response of Lewis. It describes where arterial and venous pulses can be measured, factors that influence circulation time, and provides details on the triple response of Lewis - an initial red line followed by a flare and wheal caused by the release of histamine from mast cells. Normal pulse rates are also outlined for different age groups.
heart murmur (heart extra sounds)
Heart murmurs are heart sounds produced when blood flows across one of the heart valves that is loud enough to be heard with a stethoscope.
There are two types of murmurs. A functional murmur or "physiologic murmur" is a heart murmur that is primarily due to physiologic conditions outside the heart. Other types of murmurs are due to structural defects in the heart itself. Functional murmurs are benign (an "innocent murmur").[1]
Murmurs may also be the result of various problems, such as narrowing or leaking of valves, or the presence of abnormal passages through which blood flows in or near the heart. Such murmurs, known as pathologic murmurs, should be evaluated by an expert.
Dynamic auscultation
This document describes techniques for dynamic auscultation of the heart by altering circulatory dynamics through physiological and pharmacological maneuvers. Some key techniques discussed include respiration, postural changes, Valsalva maneuver, isometric exercise, and use of vasoactive agents. Various maneuvers cause changes in heart sounds and murmurs due to effects on hemodynamics, ventricular volumes, and pressures. For example, inspiration augments murmurs on the right side of the heart while expiration accentuates some left-sided murmurs. The Valsalva maneuver and post-premature ventricular contractions also cause characteristic changes heard on auscultation.
Pulse & JVP
The document provides a review of examining pulse and jugular venous pressure (JVP). It defines pulse as the expansion and elongation of the arterial wall due to blood pressure, and JVP as the oscillating top of blood in the right internal jugular vein reflecting right atrial pressure changes.
When examining pulse, the rate, rhythm, volume, character, arterial wall condition, and peripheral pulses are assessed. Abnormal rhythms and characteristics like pulsus paradoxus are also described. Examining JVP involves observing the pressure level and waveform pattern. An elevated or changed waveform can indicate cardiac or pulmonary issues. The document outlines how to properly examine both pulse and JVP and interpret the findings.
Approach to murmurs
This document provides an overview of how to approach heart murmurs. It discusses the basics of heart sounds and cardiac cycle timing. It describes the locations used to auscultate heart sounds. Murmurs are defined as audible vibrations caused by increased turbulence in blood flow. Pathological murmurs have distinguishing characteristics like timing within the cardiac cycle. The document outlines how to describe murmurs and provides examples of different types of murmurs heard in various locations based on their timing within the cardiac cycle. It also discusses classifications of murmurs and potential causes.
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Approach to Murmur
This document provides information on assessing murmurs through auscultation of the heart. It discusses the major auscultatory sounds including heart sounds and murmurs. It describes the auscultation areas of the heart and classifications of murmurs by timing, intensity, pitch, and associated disorders. Maneuvers that can augment or reduce murmurs are presented. Investigations like echocardiography and treatments including medications and surgery are also summarized.
S3 and S4
This document discusses S3 and S4 heart sounds. S3 occurs near the end of rapid ventricular filling and is related to forces during active filling. It can be normal or indicate diastolic dysfunction. S4 follows left atrial systole and results from sudden tensing of the left ventricle. It requires a non-compliant left ventricle and indicates elevated left ventricular end-diastolic pressure. Both S3 and S4 can have physiological or pathological causes such as heart failure, hypertension, coronary artery disease and more.
Diastolic murmurs
This document discusses different types of diastolic murmurs, including their causes, characteristics, and clinical significance. There are two main types: diastolic regurgitant murmurs caused by retrograde flow across incompetent valves, and diastolic filling murmurs caused by forward flow across stenotic atrioventricular valves. Early diastolic murmurs include those from aortic and pulmonary regurgitation. Mid diastolic murmurs include those from mitral stenosis, caused by forward flow during the rapid ventricular filling phase. The characteristics of murmurs provide clues to differentiate types of structural heart disease.
Pulse tripleresponse
The document summarizes the arterial pulse, venous pulse, circulation time, and the triple response of Lewis. It describes where arterial and venous pulses can be measured, factors that influence circulation time, and provides details on the triple response of Lewis - an initial red line followed by a flare and wheal caused by the release of histamine from mast cells. Normal pulse rates are also outlined for different age groups.
heart murmur (heart extra sounds)
Heart murmurs are heart sounds produced when blood flows across one of the heart valves that is loud enough to be heard with a stethoscope.
There are two types of murmurs. A functional murmur or "physiologic murmur" is a heart murmur that is primarily due to physiologic conditions outside the heart. Other types of murmurs are due to structural defects in the heart itself. Functional murmurs are benign (an "innocent murmur").[1]
Murmurs may also be the result of various problems, such as narrowing or leaking of valves, or the presence of abnormal passages through which blood flows in or near the heart. Such murmurs, known as pathologic murmurs, should be evaluated by an expert.
Dynamic auscultation
This document describes techniques for dynamic auscultation of the heart by altering circulatory dynamics through physiological and pharmacological maneuvers. Some key techniques discussed include respiration, postural changes, Valsalva maneuver, isometric exercise, and use of vasoactive agents. Various maneuvers cause changes in heart sounds and murmurs due to effects on hemodynamics, ventricular volumes, and pressures. For example, inspiration augments murmurs on the right side of the heart while expiration accentuates some left-sided murmurs. The Valsalva maneuver and post-premature ventricular contractions also cause characteristic changes heard on auscultation.
Pulse & JVP
The document provides a review of examining pulse and jugular venous pressure (JVP). It defines pulse as the expansion and elongation of the arterial wall due to blood pressure, and JVP as the oscillating top of blood in the right internal jugular vein reflecting right atrial pressure changes.
When examining pulse, the rate, rhythm, volume, character, arterial wall condition, and peripheral pulses are assessed. Abnormal rhythms and characteristics like pulsus paradoxus are also described. Examining JVP involves observing the pressure level and waveform pattern. An elevated or changed waveform can indicate cardiac or pulmonary issues. The document outlines how to properly examine both pulse and JVP and interpret the findings.
Approach to murmurs
This document provides an overview of how to approach heart murmurs. It discusses the basics of heart sounds and cardiac cycle timing. It describes the locations used to auscultate heart sounds. Murmurs are defined as audible vibrations caused by increased turbulence in blood flow. Pathological murmurs have distinguishing characteristics like timing within the cardiac cycle. The document outlines how to describe murmurs and provides examples of different types of murmurs heard in various locations based on their timing within the cardiac cycle. It also discusses classifications of murmurs and potential causes.
Types of Arterial pulses
The document describes several types of arterial pulses:
1) Anacrotic pulses have a low amplitude with a slow rise and fall and are seen in aortic stenosis. Dicrotic pulses have two peaks, one in systole and one in diastole, and are caused by low stroke volume and decreased peripheral resistance.
2) Collapsing or water hammer pulses have a rapid upstroke and downstroke due to increased stroke volume and decreased peripheral resistance, seen in aortic regurgitation and other conditions.
3) Pulsus bisferiens has two peaks in systole, best felt in the brachial and femoral arteries and caused by conditions like aortic stenosis and regurgitation.
Continuous Murmurs
This document discusses continuous murmurs, which are murmurs that begin in systole and continue uninterrupted through diastole. The main causes of continuous murmurs are high to low pressure shunts, such as a patent ductus arteriosus (PDA) or ruptured sinus of valsalva. Continuous murmurs can also be caused by rapid blood flow, such as in hyperthyroidism. The document describes the characteristics, locations, and distinguishing features of continuous murmurs from various underlying conditions.
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This document discusses jugular venous pulse (JVP) examination and provides information on three related signs: hepatojugular reflex, Kussmaul's sign, and pulsus paradoxus. It defines each sign and explains their pathophysiology and clinical significance. The hepatojugular reflex test evaluates right heart function by observing changes in JVP during abdominal compression. Kussmaul's sign and pulsus paradoxus involve paradoxical increases or decreases in JVP and blood pressure with inspiration, respectively, and indicate conditions that restrict right ventricular filling. The document also covers techniques for evaluating these physical exam findings.
Cardiac murmurs and added sounds
This document describes various types of cardiac murmurs and added heart sounds. It defines different types of murmurs such as systolic, diastolic, and continuous murmurs. It also describes how to characterize murmurs based on timing, location, intensity, and other factors. Specific heart conditions are discussed in relation to the murmurs and sounds they may cause, such as mid-systolic murmurs indicating aortic stenosis or holosystolic murmurs indicating mitral regurgitation. Grading scales for murmur intensity and examples of maneuvers that may modify murmurs are also provided.
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Heart murmurs
This document provides an overview of different types of heart murmurs:
1. It describes systolic murmurs which occur during ventricular contraction and can be early, mid, or late systolic. Common causes are aortic stenosis, mitral regurgitation, and mitral valve prolapse.
2. It also describes diastolic murmurs which occur during ventricular relaxation and include early diastolic murmurs from aortic regurgitation and rumbling mid to late diastolic murmurs from mitral stenosis.
3. Continuous murmurs that begin in systole and continue into diastole are also discussed, along with how to characterize location and timing of different murmurs.
S3 and s4 heart sounds
S3 and S4 heart sounds are abnormal mid-diastolic and late diastolic/presystolic sounds respectively. An S3 is heard during rapid ventricular filling and can be normal in children/young adults, though it becomes less common with age. It is pathological in cases of ventricular dysfunction, excessive rapid early diastolic filling, or restrictive diseases. An S4 coincides with atrial systole and is sometimes normal in healthy old adults, but is pathological in cases of severe left ventricular hypertrophy, ischemic heart disease, aneurysms, or valvular issues. A pericardial knock occurs very early in diastole in constrictive pericarditis.
Pulse - Arterial Pulse - Types
Pulse - Arterial Pulse - type rate rhythm character delay vessel wall condition arrythmia strokes waves
Pulse
1) Pulse is the expansion and elongation of the arterial wall caused by the pressure changes during ventricular systole and diastole.
2) Irregularly irregular pulse has amplitude variation between beats and is seen in atrial fibrillation, premature ventricular contractions, and multifocal atrial tachycardia. Premature ventricular contractions cause a dropped beat followed by a compensatory pause and increased amplitude beat.
3) Bisferiens pulse has two tidal waves and is found in hypertrophic cardiomyopathy and combined aortic stenosis and regurgitation.
First heart sound. monday
S1, or the first heart sound, is predominantly caused by the closing of the mitral and tricuspid valves at the start of ventricular systole. The intensity of S1 depends on factors like the position and thickness of the mitral valve leaflets, the force of ventricular contraction, and the presence of structural heart defects. A loud S1 can indicate mitral stenosis due to elevated left atrial pressure, while a soft S1 may be due to a slow rise in left ventricular pressure or reduced valve substance from mitral regurgitation. The duration of S1 is approximately 0.15 seconds at a frequency of 25-45 Hz.
Aortic stenosis - case report
This patient presented with progressive chest pain on exertion and shortness of breath. A physical exam revealed a systolic murmur and echocardiogram showed aortic stenosis with a mean gradient of 32mm Hg and valve area of 0.88cm^2. A cardiac catheterization showed severe aortic stenosis with a peak gradient of 68mm Hg and valve area of 0.83cm^2. Given her symptoms and severity of stenosis, surgical aortic valve replacement is recommended. Coronary angiography will also be performed to assess for need for concomitant CABG prior to surgery.
Arterial pulse (The Guyton and Hall Physiology)
The arterial pulse is caused by the pressure wave that travels along the walls of the arteries when blood is ejected from the left ventricle into the aorta. As the aorta expands to accommodate the ejected blood volume, its elastic recoil causes the pressure wave. This pressure wave causes the expansion of the arterial wall, which can be felt as the arterial pulse. The velocity of the pressure wave is much faster than blood flow. Pulse pressure depends on factors like stroke volume, elasticity of arteries, and the character of blood ejection from the left ventricle. Examining the arterial pulse provides information about heart rate, rhythm, and can help diagnose diseases.
Arterial prateek
The document discusses arterial pulses, including:
1. The rate at which the pulse wave travels through arteries is independent of blood flow rate and is fastest in small arteries.
2. Common peripheral pulses that can be felt include the radial, carotid, brachial, femoral, popliteal, posterior tibial, and dorsalis pedis pulses.
3. Features of a pulse that can be assessed include rate, rhythm, volume, character, and conditions like radio-radial delay. Abnormal pulses include hypokinetic, collapsing, bisferiens, and paradoxical pulses.
Aortic stenosis
1. Aortic stenosis can be caused by rheumatic heart disease, congenital abnormalities of the aortic valve, or age-related degeneration and calcification of the valve.
2. Obstructed left ventricular outflow due to aortic stenosis leads to increased pressure and compensatory hypertrophy of the left ventricle. While cardiac output is maintained at rest, it often fails to rise normally during exertion in severe aortic stenosis.
3. Symptoms of aortic stenosis include angina, syncope, exertional dyspnea, and heart failure, which typically appear when the aortic orifice is reduced to one third of its normal size. Valve replacement surgery is
ECG: Type II Second degree SA Block
This ECG shows a 58-year-old female patient who presented with chest pain. The ECG reveals sinus rhythm with 5:4 second-degree sinoatrial exit block, where every fifth impulse is blocked at the SA junction. This type of SA block is characterized by no change in P-R interval before the pause and a pause interval that equals approximately two to four times the normal P-P cycle length. SA node dysfunction can be intrinsic, due to degenerative causes like fibrosis, or extrinsic, due to autonomic influences or drugs that suppress the SA node. Diagnosis is usually clinical or via ECG and pacemaker implantation may be indicated for symptomatic patients.
The arterial pulse
The document discusses the arterial pulse, including:
1. The pulse is a wave felt by fingers produced by cardiac systole that travels through arteries faster than blood flow. Different arteries have different time lags from cardiac systole.
2. The pulse provides important information about heart function, circulation, and arterial health. It can help detect arrhythmias and diagnose conditions like aortic regurgitation and heart failure.
3. The pulse should be examined in multiple locations and compared between sides. Features like rate, rhythm, volume, and characteristics provide clues to cardiovascular conditions. Certain pulse types indicate specific problems like aortic stenosis or mitral regurgitation.
Aortic stenosis
This document discusses aortic stenosis and aortic regurgitation. It defines aortic stenosis as a narrowing of the aortic valve opening, with common causes being a bicuspid aortic valve, calcification, or rheumatic heart disease. Symptoms include angina, syncope, and dyspnea. Diagnosis involves echocardiography. Treatment options are balloon valvuloplasty or valve replacement. Aortic regurgitation is defined as retrograde blood flow through the aortic valve during diastole. Common causes are rheumatic fever, hypertension, or a bicuspid valve. Symptoms progress from palpitations to dyspnea. Physical exam may reveal a wide pulse pressure.
Examination of pulse
The document discusses examination of various pulses and abnormalities that may be present. It examines pulses at different locations that should be checked and differences that may indicate issues. Specific abnormalities are then defined and causes explained, including pulsus alternans indicating left ventricular failure, pulsus paradoxus seen in cardiac tamponade, and characteristics of pulses in aortic stenosis like an anacrotic pulse and delayed upstroke.
Pulse wave analysis
This document discusses pulse wave analysis and central blood pressure. It explains that pulse wave velocity analysis can provide information about arterial stiffness and wave reflections that influence central blood pressure, which may be a better indicator of cardiovascular risk than brachial blood pressure. A study at Bahrain Specialist Hospital found that central systolic blood pressure was significantly lower than brachial systolic pressure, with a lower central pulse pressure, indicating increased pulse pressure amplification. Central blood pressure and measures of arterial stiffness like augmentation pressure were more strongly correlated with age and showed the effects of antihypertensive drugs better than brachial pressure measurements.
Approach to Heart Murmurs
This document discusses the approach to evaluating heart murmurs. It defines different types of murmurs including systolic, diastolic, and continuous murmurs. It describes the characteristics of various murmurs such as location, radiation, intensity and duration. Specific examples are provided of murmurs caused by conditions like aortic stenosis, mitral regurgitation, patent ductus arteriosus, and ventricular septal defects. The document provides guidance on distinguishing normal from abnormal findings on heart examination.
Image of the Week 1
The guidewire is not advancing further during a procedure. There are 4 proposed next steps: 1) Call vascular surgery, 2) Switch to radial access, 3) Deploy covered stent, 4) Retract and redirect the wire. The correct answer is to retract and redirect the wire as images show it had taken a lateral course into the deep circumflex iliac artery rather than the intended external iliac artery. Simply redirecting the wire was successful in advancing it into the correct external iliac artery location without complications.
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Types of Arterial pulses
The document describes several types of arterial pulses:
1) Anacrotic pulses have a low amplitude with a slow rise and fall and are seen in aortic stenosis. Dicrotic pulses have two peaks, one in systole and one in diastole, and are caused by low stroke volume and decreased peripheral resistance.
2) Collapsing or water hammer pulses have a rapid upstroke and downstroke due to increased stroke volume and decreased peripheral resistance, seen in aortic regurgitation and other conditions.
3) Pulsus bisferiens has two peaks in systole, best felt in the brachial and femoral arteries and caused by conditions like aortic stenosis and regurgitation.
Continuous Murmurs
This document discusses continuous murmurs, which are murmurs that begin in systole and continue uninterrupted through diastole. The main causes of continuous murmurs are high to low pressure shunts, such as a patent ductus arteriosus (PDA) or ruptured sinus of valsalva. Continuous murmurs can also be caused by rapid blood flow, such as in hyperthyroidism. The document describes the characteristics, locations, and distinguishing features of continuous murmurs from various underlying conditions.
JVP by Dr Manish Ruhela
This document discusses jugular venous pulse (JVP) examination and provides information on three related signs: hepatojugular reflex, Kussmaul's sign, and pulsus paradoxus. It defines each sign and explains their pathophysiology and clinical significance. The hepatojugular reflex test evaluates right heart function by observing changes in JVP during abdominal compression. Kussmaul's sign and pulsus paradoxus involve paradoxical increases or decreases in JVP and blood pressure with inspiration, respectively, and indicate conditions that restrict right ventricular filling. The document also covers techniques for evaluating these physical exam findings.
Cardiac murmurs and added sounds
This document describes various types of cardiac murmurs and added heart sounds. It defines different types of murmurs such as systolic, diastolic, and continuous murmurs. It also describes how to characterize murmurs based on timing, location, intensity, and other factors. Specific heart conditions are discussed in relation to the murmurs and sounds they may cause, such as mid-systolic murmurs indicating aortic stenosis or holosystolic murmurs indicating mitral regurgitation. Grading scales for murmur intensity and examples of maneuvers that may modify murmurs are also provided.
Mitral Stenosis with pulsus alternans
This document summarizes a case study of a 73-year-old woman with mitral stenosis who presented with dyspnea, fatigue, and edema. Hemodynamic evaluation found unusual pulsus alternans and an improvement in pressures and gradients with beta-blocker treatment. Direct left atrial pressure measurement confirmed moderate prosthetic mitral stenosis. The presence of pulsus alternans in mitral stenosis and hemodynamic improvement with beta-blockers made this an interesting case to report.
Heart murmurs
This document provides an overview of different types of heart murmurs:
1. It describes systolic murmurs which occur during ventricular contraction and can be early, mid, or late systolic. Common causes are aortic stenosis, mitral regurgitation, and mitral valve prolapse.
2. It also describes diastolic murmurs which occur during ventricular relaxation and include early diastolic murmurs from aortic regurgitation and rumbling mid to late diastolic murmurs from mitral stenosis.
3. Continuous murmurs that begin in systole and continue into diastole are also discussed, along with how to characterize location and timing of different murmurs.
S3 and s4 heart sounds
S3 and S4 heart sounds are abnormal mid-diastolic and late diastolic/presystolic sounds respectively. An S3 is heard during rapid ventricular filling and can be normal in children/young adults, though it becomes less common with age. It is pathological in cases of ventricular dysfunction, excessive rapid early diastolic filling, or restrictive diseases. An S4 coincides with atrial systole and is sometimes normal in healthy old adults, but is pathological in cases of severe left ventricular hypertrophy, ischemic heart disease, aneurysms, or valvular issues. A pericardial knock occurs very early in diastole in constrictive pericarditis.
Pulse - Arterial Pulse - Types
Pulse - Arterial Pulse - type rate rhythm character delay vessel wall condition arrythmia strokes waves
Pulse
1) Pulse is the expansion and elongation of the arterial wall caused by the pressure changes during ventricular systole and diastole.
2) Irregularly irregular pulse has amplitude variation between beats and is seen in atrial fibrillation, premature ventricular contractions, and multifocal atrial tachycardia. Premature ventricular contractions cause a dropped beat followed by a compensatory pause and increased amplitude beat.
3) Bisferiens pulse has two tidal waves and is found in hypertrophic cardiomyopathy and combined aortic stenosis and regurgitation.
First heart sound. monday
S1, or the first heart sound, is predominantly caused by the closing of the mitral and tricuspid valves at the start of ventricular systole. The intensity of S1 depends on factors like the position and thickness of the mitral valve leaflets, the force of ventricular contraction, and the presence of structural heart defects. A loud S1 can indicate mitral stenosis due to elevated left atrial pressure, while a soft S1 may be due to a slow rise in left ventricular pressure or reduced valve substance from mitral regurgitation. The duration of S1 is approximately 0.15 seconds at a frequency of 25-45 Hz.
Aortic stenosis - case report
This patient presented with progressive chest pain on exertion and shortness of breath. A physical exam revealed a systolic murmur and echocardiogram showed aortic stenosis with a mean gradient of 32mm Hg and valve area of 0.88cm^2. A cardiac catheterization showed severe aortic stenosis with a peak gradient of 68mm Hg and valve area of 0.83cm^2. Given her symptoms and severity of stenosis, surgical aortic valve replacement is recommended. Coronary angiography will also be performed to assess for need for concomitant CABG prior to surgery.
Arterial pulse (The Guyton and Hall Physiology)
The arterial pulse is caused by the pressure wave that travels along the walls of the arteries when blood is ejected from the left ventricle into the aorta. As the aorta expands to accommodate the ejected blood volume, its elastic recoil causes the pressure wave. This pressure wave causes the expansion of the arterial wall, which can be felt as the arterial pulse. The velocity of the pressure wave is much faster than blood flow. Pulse pressure depends on factors like stroke volume, elasticity of arteries, and the character of blood ejection from the left ventricle. Examining the arterial pulse provides information about heart rate, rhythm, and can help diagnose diseases.
Arterial prateek
The document discusses arterial pulses, including:
1. The rate at which the pulse wave travels through arteries is independent of blood flow rate and is fastest in small arteries.
2. Common peripheral pulses that can be felt include the radial, carotid, brachial, femoral, popliteal, posterior tibial, and dorsalis pedis pulses.
3. Features of a pulse that can be assessed include rate, rhythm, volume, character, and conditions like radio-radial delay. Abnormal pulses include hypokinetic, collapsing, bisferiens, and paradoxical pulses.
Aortic stenosis
1. Aortic stenosis can be caused by rheumatic heart disease, congenital abnormalities of the aortic valve, or age-related degeneration and calcification of the valve.
2. Obstructed left ventricular outflow due to aortic stenosis leads to increased pressure and compensatory hypertrophy of the left ventricle. While cardiac output is maintained at rest, it often fails to rise normally during exertion in severe aortic stenosis.
3. Symptoms of aortic stenosis include angina, syncope, exertional dyspnea, and heart failure, which typically appear when the aortic orifice is reduced to one third of its normal size. Valve replacement surgery is
ECG: Type II Second degree SA Block
This ECG shows a 58-year-old female patient who presented with chest pain. The ECG reveals sinus rhythm with 5:4 second-degree sinoatrial exit block, where every fifth impulse is blocked at the SA junction. This type of SA block is characterized by no change in P-R interval before the pause and a pause interval that equals approximately two to four times the normal P-P cycle length. SA node dysfunction can be intrinsic, due to degenerative causes like fibrosis, or extrinsic, due to autonomic influences or drugs that suppress the SA node. Diagnosis is usually clinical or via ECG and pacemaker implantation may be indicated for symptomatic patients.
The arterial pulse
The document discusses the arterial pulse, including:
1. The pulse is a wave felt by fingers produced by cardiac systole that travels through arteries faster than blood flow. Different arteries have different time lags from cardiac systole.
2. The pulse provides important information about heart function, circulation, and arterial health. It can help detect arrhythmias and diagnose conditions like aortic regurgitation and heart failure.
3. The pulse should be examined in multiple locations and compared between sides. Features like rate, rhythm, volume, and characteristics provide clues to cardiovascular conditions. Certain pulse types indicate specific problems like aortic stenosis or mitral regurgitation.
Aortic stenosis
This document discusses aortic stenosis and aortic regurgitation. It defines aortic stenosis as a narrowing of the aortic valve opening, with common causes being a bicuspid aortic valve, calcification, or rheumatic heart disease. Symptoms include angina, syncope, and dyspnea. Diagnosis involves echocardiography. Treatment options are balloon valvuloplasty or valve replacement. Aortic regurgitation is defined as retrograde blood flow through the aortic valve during diastole. Common causes are rheumatic fever, hypertension, or a bicuspid valve. Symptoms progress from palpitations to dyspnea. Physical exam may reveal a wide pulse pressure.
Examination of pulse
The document discusses examination of various pulses and abnormalities that may be present. It examines pulses at different locations that should be checked and differences that may indicate issues. Specific abnormalities are then defined and causes explained, including pulsus alternans indicating left ventricular failure, pulsus paradoxus seen in cardiac tamponade, and characteristics of pulses in aortic stenosis like an anacrotic pulse and delayed upstroke.
Pulse wave analysis
This document discusses pulse wave analysis and central blood pressure. It explains that pulse wave velocity analysis can provide information about arterial stiffness and wave reflections that influence central blood pressure, which may be a better indicator of cardiovascular risk than brachial blood pressure. A study at Bahrain Specialist Hospital found that central systolic blood pressure was significantly lower than brachial systolic pressure, with a lower central pulse pressure, indicating increased pulse pressure amplification. Central blood pressure and measures of arterial stiffness like augmentation pressure were more strongly correlated with age and showed the effects of antihypertensive drugs better than brachial pressure measurements.
Approach to Heart Murmurs
This document discusses the approach to evaluating heart murmurs. It defines different types of murmurs including systolic, diastolic, and continuous murmurs. It describes the characteristics of various murmurs such as location, radiation, intensity and duration. Specific examples are provided of murmurs caused by conditions like aortic stenosis, mitral regurgitation, patent ductus arteriosus, and ventricular septal defects. The document provides guidance on distinguishing normal from abnormal findings on heart examination.
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"Konkursowicze - jak z nimi żyć, żeby nie zabić się własną pięścią"
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The document describes various hemodynamic measurements and pressure tracings obtained from right heart catheterization. It discusses normal and abnormal left ventricular pressure tracings and their components during systole and diastole. It also describes normal and abnormal right atrial, right ventricular, pulmonary artery, and pulmonary capillary wedge pressure tracings, including how different disease states can affect the pressure waveform morphology. Various concepts in hemodynamic measurements are summarized such as timing of pressure waves, effects of respiration, and identifying features of common cardiac pathologies.
Mimicks Masks of Myocardial Infarction.pptx
This document discusses various ECG patterns that can mimic myocardial infarction (MI) or mask an underlying MI. It describes patterns seen in conditions like non-infarction ischemia, acute pericarditis, LVH, LBBB, pulmonary embolism, Brugada syndrome, hypothermia, hyperkalemia, and WPW syndrome. It provides the characteristic ECG findings and mechanisms for each of these conditions and discusses how they can simulate or obscure the signs of an acute MI on ECG.
Mitral regurgitation by dr kalpana chetia
Mitral regurgitation - rheumatic heart disease is the commonest cause of MR. It coexists with MS and AR, particularly Ar
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This document contains a quiz with multiple choice questions about ECG interpretations. Some key findings included in the questions are right bundle branch block with left posterior hemiblock, third degree atrioventricular block, left bundle branch block with Cabrera's sign indicating possible myocardial infarction, Wolff-Parkinson-White syndrome type A, ventricular tachycardia, atrial fibrillation, premature ventricular contractions, left ventricular hypertrophy, anterior myocardial infarction, hyperkalemia, and more. The document also includes explanations of ECG patterns and signs such as bundle branch blocks, ventricular tachycardia criteria, Wellens' phenomenon, hyperacute T waves, and more.
Mimicks n Masks of MI.pptx
1. The document discusses various ECG patterns that can mimic myocardial infarction (MI), including non-infarction ischemia, pericarditis, LVH, LBBB, pulmonary embolism, Brugada pattern, and hypothermia.
2. It also discusses ECG patterns in MI that can be masked or obscured by other conditions, such as WPW syndrome, LBBB, RBBB, ventricular pacing rhythms, and hypothermia.
3. Criteria are provided to help differentiate MI patterns from mimics in some challenging cases, such as with LBBB, RBBB, ventricular pacing, or hypothermia present.
Mitral regurgitation
Mitral valve anatomy
Mitral Regurgitation
Etiology
Pathology
Primary mitral regurgitation
Secondary mitral regurgitation
Functional Classification
Pathophysiology
Acute phase
Chronic compensated phase
Clinical Manifestations
Physical examination
Investigations
classification of severity
Indication for surgery
MV operations for correction of MR
Repolarization ST wave Abnormalities
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Precise guide for Allied Health Science Students especially cardiac specialty students, DGNM, B.Sc Nursing & M.Sc Nursing Students regarding Repolarization ST wave Abnormalities.
ECHOCARDIOGRAPHIC ASSESMENT OF DIASTOLIC FUNCTION.pptx
This document discusses the assessment of diastolic function by echocardiography. It begins with an introduction to diastole and diastolic dysfunction. It then covers the determinants of diastolic function, epidemiology of heart failure with preserved ejection fraction, and how echocardiography can be used to evaluate diastolic function through Doppler measurements of mitral inflow and pulmonary venous flow. Parameters like E/A ratio, E-wave deceleration time, isovolumetric relaxation time, and tissue Doppler imaging are discussed. The document provides an overview of how echocardiography can grade diastolic dysfunction.
ST SEGMENT IN ECG,ST ELEVATION AND ST DEPRESSION
The document discusses the ST segment of the ECG and various abnormalities that can occur. It notes that the ST segment represents the interval between ventricular depolarization and repolarization. ST segment elevation or depression can indicate myocardial ischemia or infarction. Various conditions are described that can cause ST segment changes, including myocardial infarction in different coronary artery territories, coronary vasospasm, pericarditis, early repolarization, and others. The morphology and patterns of ST segment abnormalities are discussed for evaluating these conditions.
phases of cardiac cycle.pdf
The cardiac cycle consists of 7 phases that correlate with an ECG reading. Phase 1 is atrial systole seen as the P wave, Phase 2 is isovolumetric contraction seen as the QRS complex, Phases 3-4 are ventricular contraction and ejection, Phase 5 is isovolumetric relaxation seen as the T wave, and Phases 6-7 are ventricular filling. The document describes each phase of the cardiac cycle and its corresponding feature on an ECG.
Mitral stenosis
This document provides an overview of the pathophysiology of mitral valve disease. It discusses the anatomy of the mitral valve and the various causes of mitral stenosis, including rheumatic fever which is the predominant cause. It describes the characteristic rheumatic changes to the mitral valve that result in stenosis, including thickening, fusion and shortening of the leaflets and chordae tendineae. It also explains the physiological effects of mitral stenosis, such as increased left atrial pressure and pulmonary hypertension, and the resulting symptoms experienced by patients.
Cardiac manuveres
The document summarizes various cardiac maneuvers and their effects on heart sounds and murmurs. It describes the Valsalva maneuver in detail including its four phases and use of the Valsalva ratio. It also discusses the Muller maneuver, isometric exercises like handgrip, positional changes, respiration, and pharmacological agents like amyl nitrite and their impacts on evaluating heart conditions.
Interpretation of ecg_in_pulmonary_disease
This document discusses ECG findings in patients with pulmonary diseases such as chronic obstructive pulmonary disease (COPD) and pulmonary embolism (PE). It describes changes seen in COPD such as right axis deviation, low voltage complexes, and right ventricular hypertrophy. It also outlines typical findings in PE including sinus tachycardia, right ventricular strain pattern, complete or incomplete right bundle branch block, and S1Q3T3 pattern. The document provides details on diagnostic criteria for right atrial enlargement, right ventricular hypertrophy, and right bundle branch block.
Samir rafla ecg for teaching-answer at end
This document discusses several electrocardiogram (ECG) findings:
1. A right bundle branch block with left axis deviation can indicate bifascicular block. T wave inversions in V1-V3 can be due to right bundle branch block or previous anterior wall myocardial infarction.
2. Brugada Syndrome Type 2.
3. Very rapid atrial fibrillation with a wide QRS indicates Wolff-Parkinson-White syndrome due to an accessory pathway with aberrant conduction.
Samir rafla ecg for teaching-answer at end
This document discusses several electrocardiogram (ECG) findings:
1. A right bundle branch block with left axis deviation can indicate bifascicular block. T wave inversions in V1-V3 can be due to right bundle branch block or previous anterior wall myocardial infarction.
2. Brugada Syndrome Type 2.
3. Very rapid atrial fibrillation with a wide QRS complex indicates an accessory pathway leading to aberrant conduction, consistent with Wolff-Parkinson-White syndrome.
JVP SURAJIT.pptx
The venous system contains about 70–80% of the circulating blood volume which is non-pulsatile. However, changes in flow and pressure caused by the right atrial and right ventricular filling produce pulsations in the central veins that are transmitted to the peripheral veins (e.g. jugular veins) and are opposite to the direction of the blood flow.
●
The arterial pulse and blood pressure reflects the dynamics of the left side of the heart, while the jugular veins provide the information about the hemodynamic events from the right side of the heart-right atrial pressure during systole and right ventricular filling pressure during diastole.
●
Hence, an accurate assessment of the venous pulse, the jugular venous pulse (JVP) reflects the dynamics of the right side of the heart.1
History ●
Lancis (1728) first described the cervical venous pulse of the external jugular vein in a patient with tricuspid regurgitation (see Table 16.1).
●
However, the classic graphic recordings of the JVP were done by Chauvea and Marey (1863).
●
But it was Potain (1869) who accurately described the wave pattern in the internal jugular vein.
Giant a Waves or Cannon Waves
These occur whenever the RA contracts against the closed TV during RV systole. Paul Wood described the giant a wave as ‘venous Corrigan’. Cannon waves may occur either regularly or irregularly and are most common in the presence of arrhythmias. ●
Regular cannon waves occur in – Junctional rhythm – Ventricular tachycardia (VT) 1:1 retrograde conduction – Isorhythmic AV dissociation
●
Irregular cannon waves occur in – Complete heart block (see Fig. 16.6) – Classic AV dissociation –VT – Ventricular pacing – Ventricular ectopics
Heart
The document describes various imaging modalities used to diagnose cardiovascular conditions:
1. Transesophageal echocardiography images show a dilated aorta with an intimal flap, indicating an aortic dissection, along with a large jet of aortic regurgitation.
2. Angiography demonstrates a large fusiform aneurysm of the descending thoracic aorta.
3. Computed tomography angiography images reveal a fusiform abdominal aortic aneurysm that has been treated with an endovascular stent graft.
4. Atheroembolism, or embolization of cholesterol crystals, can cause cyanosis and necrosis of the toes, known as "blue toe syndrome".
Jugular Venous Pulse (JVP).pptx
The Jugular Venous Pulse (JVP) indirectly measures pressure in the right atrium. It is examined by observing pulsations in the right internal jugular vein. A raised JVP can indicate issues like superior vena cava syndrome or chronic constrictive pericarditis. The normal waveform contains an a wave, x descent, c wave, v wave, and y descent corresponding to pressures changes in the heart during the cardiac cycle. Abnormalities in the waveform can suggest problems like atrial fibrillation, tricuspid stenosis, or tamponade. Additional signs like abdominal jugular reflux or Friederick's sign can also provide clues about right heart function.
JVP - A SHORT REVIEW
The jugular venous pulse reflects right atrial pressure and is best examined in the right internal jugular vein. It normally displays three positive waves and two negative troughs related to atrial filling and emptying. Abnormalities can indicate conditions that elevate or lower right atrial pressure such as heart failure, tamponade, constriction. Specific wave changes suggest problems like tricuspid regurgitation or stenosis. The jugular venous pulse is a useful physical exam finding for cardiovascular assessment.
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- 1. What is the diagnosis? Valsalva 1. Tamponade 2. Constriction 3. Restriction 4. Mitral regurgitation 5. LV dysfunction
- 2. Valsalva Figure 1. “square wave sign” Figure 3. Frank Starling curve in patients with left ventricular dysfunction and increased ventricular diastolic pressures Figure 2. Normal Valsalva response Correct Answer: Left ventricular dysfunction A normal Valsalva response has 4 phases (Figure 2). In phase 1 a transient increase in blood pressure is observed due to straining. In phase 2, blood pressure and pulse pressure decrease, while the hear rate increases, due to decrease in left ventricular filling and decrease in stroke volume. In phase 3, release of straining causes a further transient decrease in blood pressure. In phase 4, arterial pressure increases and heart rate decreases. Patients with left ventricular dysfunction and increase in the left ventricular diastolic pressures operate on the descending limb of the Frank Starling curve (point A, Figure 3). Straining during the Valsalva maneuver decreases preload, which increases stroke volume (point B, Figure 3) and arterial systolic pressure. This response to the Valsalva maneuver is called the “square wave sign”.
- 3. References: 1. Maniu CV, Nishimura RA, Tajik AJ. Tachycardia during the valsalva maneuver: a sign of normal diastolic filling pressures. J Am Soc Echocardiogr 2004;17:634-7. 2. Nishimura RA, Tajik AJ. The Valsalva maneuver and response revisited. Mayo Clin Proc 1986;61:211-7.