Cardiac Clinical Cases

Question 1

Percussion of the heart

Answer 1

-density and size of the heart
-vibration by tapping -> listen and feel for difference sound wave conduction
-3rd, 4th, and 5th intercostal spaces from left to right anterior axillary line
-resonance is dull (because of heart) at 6 cm lateral to the left border of the sternum

Question 2

atrial septal defects (ASDs)

Answer 2

-Congenital interatrial septum defect
-incomplete closure of the oval foramen
-probe-size patency in superior part of oval fossa
-15–25%
-small ASDs -> no clinical significance
-large ASDs -> oxygenated blood from lungs -> left atrium -> right atrium
-enlargement of right atrium and ventricle
-dilation of the pulmonary trunk.

Question 3

ventricular septal defects (VSDs)

Answer 3

-membranous part of IV septum develops separately from muscular part
-this part is common site of defects
-most common congenital malformations
-from 1-25 mm
-left-to-right shunt of blood through defect
-large -> increases pulmonary blood flow -> causes pulmonary disease
-hypertension and may cause cardiac failure

Question 4

thrombi

Answer 4

-clots on the walls of left atrium
-in some heart diseases
-detach or break off -> go into systemic circulation -> occlude peripheral arteries
-Occlusion of artery in brain -> stroke or cerebrovascular accident (CVA) -> effect vision, cognition, or sensory or motor function

Question 5

stenosis and regurgitation

Answer 5

-Valvular heart disease: stenosis (narrowing) or insufficiency (regurgitation)
-failure of valve to open fully -> slows flow
-regurgitation- failure of valve to close completely -> back flow
-regurgitation usually forms from nodule formation on (or scarring) the cusps -> edges dont meet or align
-Both -> increase workload
-Restriction of high-pressure blood flow (stenosis) and passage of blood through a narrow opening into a larger vessel or chamber (stenosis and regurgitation) produce turbulence
-Turbulence creates eddies (small whirlpools) -> produce vibrations -> murmurs
-Superficial vibrations -> thrills -> felt on skin over area of turbulence
-mechanical problem
-valvuloplasty- replace defective valves surgically

Question 6

valve defects

Answer 6

-prolapsed mitral valve- 1 or both leaflets are enlarged, redundant, or “floppy,” and extending back into the left atrium during systole -> back flow -> murmur
-Aortic valve stenosis -> left ventricular hypertrophy
-aortic valve stenosis is most frequent valve abnormality and usually results from degenerative calcification
-pulmonary valve stenosis -> cusps fused -> dome with narrow central opening
-infundibular pulmonary stenosis- conus arteriosus is underdeveloped -> restriction of right ventricular outflow -> degree of hypertrophy of the right ventricle is variable

Question 7

Coronary Artery Disease or Coronary Heart Disease

Answer 7

-one of leading causes of death
-caused by reduced blood supply to vital myocardial tissue

Question 8

Myocardial Infarction

Answer 8

-sudden occlusion of major artery by embolus
-region of myocardium supplied by the occluded vessel becomes infarcted -> necrosis
-3 most common sites of coronary artery occlusion:
-1. anterior IV (LAD) branch of the LCA (40–50%)
-2. RCA (30–40%)
-3. circumflex branch of the LCA (15–20%)
-myocardial infarction (MI)- area of myocardium that has necrosis
-coronary artery insufficiency from atherosclerosis -> MC cause of ischemic heart disease

Question 9

coronary atherosclerosis

Answer 9

-characterized by lipid deposits in the intima of coronary arteries
-begins during early adulthood
-results in stenosis of lumina of arteries
-insufficiency of blood supply to the heart (myocardial ischemia) -> MI