Cardiovascular anatomy 3 Flashcards
Describe the x-descent of the jugular venous pulse
- Downward displacement of closed tricuspid of closed tricuspid valve during rapid ventricular ejection phase
- Reduced or absent in tricuspid regurgitation and right HF because pressure gradients are reduced
Describe the v-wave of the jugular venous pulse
Increased right atrial pressure due to filling (“villing”) against closed tricuspid valve.
The y-descent is prominent in?
Constrictive pericarditis
The y-descent is absent in?
Cardiac tamponade
Describe the y-descent
RA emptying into RV
Constrictive pericarditis JVP features
The y-descent is prominent
Cardiac tamponade JVP features
The y-descent is absent
Atrial fibrillation JVP features
The a-wave is absent
Types of heart sound splitting
Normal splitting Wide splitting Fixed splitting Paradoxical splitting
Describe normal splitting
Inspiration -> drop in intrathoracic pressure -> increased venous return -> increased RV filling -> increased RV stroke volume -> increased RV ejection time -> delayed closure of the pulmonic valve Decreased pulmonary impedance (increased capacity of the pulmonary circulation) also occurs during inspiration, which contributes to delayed closure of the pulmonic valve
Describe wide splitting
Seen in conditions that delay RV emptying (e.g. pulmonic stenosis, right bundle branch block)
Wide splitting occurs in?
Causes delayed pulmonic sound (especially on inspiration) an exaggeration of normal splitting
Describe fixed splitting
ASD -> left-to-right shunt -> increased RA and RV volumes -> increased flow through pulmonic valve such that, regardless of breath, pulmonic closure is greatly delayed
Fixed splitting occurs in?
Heard in ASD
Describe paradoxical splitting
Normal order of valve closure is reversed so that P2 sound occurs before delayed A2 sound, therefore on inspiration, P2 closes later and moves closer to A2, thereby paradoxically eliminating the split (usually heard in expiration)
Paradoxical splitting occurs in?
Conditions that delay aortic valve closure (e.g. aortic stenosis, left bundle branch block), usually heard in expiration
Where is the aortic valve best auscultated?
2nd intercostal space right sternal border
Where is the pulmonic valve best auscultated?
2nd intercostal space left sternal border
Where is the tricuspid valve best auscultated?
5th intercostal space left sternal border
Where is the mitral valve best auscultated?
5th intercostal space left mid-clavicular line
Where is aortic stenosis best auscultated?
Right 2nd intercostal space right sternal border
Where is aortic valve sclerosis best auscultated?
Right 2nd intercostal space right sternal border
What part of the cardiac cycle does aortic regurgitation occur?
Diastolic murmur
Where is aortic regurgitation best auscultated?
3rd intercostal space left sternal border
Where is pulmonic regurgitation best auscultated?
3rd intercostal space left sternal border
Where is hypertrophic cardiomyopathy best auscultated?
3rd intercostal space left sternal border
What part of the cardiac cycle does pulmonic regurgitation occur?
Diastolic murmur
When is the murmur of hypertrophic cardiomyopathy best heard?
Systolic murmur
Where is pulmonic stenosis best auscultated?
2nd intercostal space left sternal border
Where is Atrial Septal Defect best auscultated?
2nd intercostal space left sternal border
Where is tricuspid regurgitation best auscultated?
5th intercostal space left sternal border
Where is a ventricular septal defect murmur best auscultated?
5th intercostal space left sternal border
Where is tricuspid stenosis best auscultated?
5th intercostal space left sternal border
What part of the cardiac cycle does Tricuspid regurgitation occur?
Holosystolic murmur
What part of the cardiac cycle does a ventricular septal defect murmur occur?
Holosystolic murmur
What part of the cardiac cycle does Tricuspid stenosis occur?
Diastolic murmur
What part of the cardiac cycle does mitral regurgitation occur?
Holosystolic murmur
What part of the cardiac cycle does mitral valve prolapse occur?
Systolic murmur
What part of the cardiac cycle does mitral stenosis occur?
Diastolic murmur
Where is mitral regurgitation best auscultated?
5th intercostal space left mid-clavicular line
Where is mitral valve prolapse best auscultated?
5th intercostal space left mid-clavicular line
Where is mitral stenosis best auscultated?
5th intercostal space left mid-clavicular line
What effect does inspiration have on heart sounds?
Increases venous return to the right atrium and increases the intensity of right heart sounds
What effect does hand-grip have on heart sounds?
Increases afterload and thereby increasing the intensity of MR, AR and VSD murmurs Decreases the intensity of hypertrophic cardiomyopathy and AS murmurs In mitral valve prolapse, there is an later onset of the click/murmur
What effect does the Valsalva maneuver have on heart sounds?
Decreases the intensity of most murmurs (including AS) Increases the intensity of hypertrophic cardiomyopathic murmurs In mitral valve prolapse there is an earlier onset of click/murmur
What effect does rapid squatting have on heart sounds?
Increases venous return, increases preload, increases afterload Decreases the intensity of hypertrophic cardiomyopathic murmurs In mitral valve prolapse there is a later onset of click/murmur
What are the systolic murmurs?
Aortic stenosis pulmonary stenosis Mitral regurgitation Tricuspid regurgitation VSD MVP Hypertrophic cardiomyopathy
What are the diastolic murmurs?
Aortic regurgitation Pulmonic regurgitation Mitral stenosis Tricsupid stenosis
Describe the murmur of aortic stenosis?
Crescendo-decrescendo systolic ejection murmur and soft S2 (ejection click may be present) LV >> aortic pressure during systole. Loudest at the heart base; radiates to carotids. “Pulsus parvus et tardus” - pulses are weak with a delayed peak. Can lead to syncope, angina and dyspnea on exertion (SAD). Most commonly due to age-related calcification in older patients (> 60 years old) or in younger patients with early-onset calcification of bicuspid aortic valve.
Common cause of Aortic stenosis
Age-related calcification in >70 years old or a congenital bicuspid aortic valve <70 years old
