Chapter 14 outline Flashcards
Between what costal cartilage is the heart located?
behind the sternum between 3rd and 6th costal cartilage
What is the top and bottom of the heart called?
base (top) bottom (apex)
What is it called when your heart is positioned to the right instead of the left?
dextrocardia
if the heart and stomach are on the right and liver on the left it is called?
situs inversus (rare)
What is the double-walled fibrous sac with fluid in between the walls = low friction movement
pericardium
What is the outermost layer of heart
epicardium
What is the muscle layer responsible for pumping?
myocardium
What lines the chambers of heart and covers heart valves?
endocardium
Name the layers of the pericardium from outermost to inner most?
Epicardium ->Myocardium -> Endocardium
Name the four chambers of the heart, their thickness and what they do?
2 X atria (thin walled)-house blood returning from veins
2 X ventricles (thick walled) pump blood into arteries
The left and right chambers of the heart are separated by (blank), which is impenetrable to blood
interventricular septum
What are the two types of important valves of the heart and what do they do?
Atrioventricular
• Tricuspid = between right atrium and right ventricle
• Bicuspid/Mitral = between left atrium and left ventricle
Semilunar
• Pulmonic = between right ventricle and pulmonary artery
• Aortic = between left ventricle and aorta
Where is the tricupsid located?
between right atrium and right ventricle
Where is the bicuspid/mitral valve located?
between left atrium and left ventricle
Where is the pulmonic valves located?
between right ventrical and pulmonary artery
Where is the aortic valve located?
between left ventricle and aorta.
What happens during systole?
ventricles contract to eject blood into arteries ( aortic and pulmonary)
What happens during diastole?
atria contract to get blood into ventricles
During the S1 what do you hear and what happens?
lubb, tricuspid and mitral valves CLOSE as ventricle contracts
During the S2 what do you hear and what happens?
dubb aortic and pulmonic valves CLOSE when ventricle is empty
• 2 components (not always distinguishable):
o A2 and P2
A2 aortic valve closes = happens first
P2 pulmonic valve closes = happens second
During the S3 what happens?
sound of blood rushing from atria to ventricles = not always heard
During S4 what happens?
atria fully contract to make sure no blood is left in atria = also not always heard
What is the path of impulse for a ECG?
SA (sinoatrial) Node -> AV (atrioventricular) Node -> Bundle of His -> Purkinje Fibers in ventricles
What does the ECG path of impulse allow for and how does the ventricular contraction move?
Atria contract before ventricles and contraction begins at apex and moves toward the base
What are ECG waves based on?
Based on depolarization and repolarization of cardiac myocytes
Describe the ECG waves
P Wave atrial depolarization
PR interval time in between atrial depolarization and ventricular depolarization
QRS complex ventricular depolarization
ST segment and T wave ventricular repolarization
U wave small deflection seen after T wave
QT interval time between onset of ventricular depolarization and completion
of ventricular repolarization=pretty much systole
explain the path of blood flow for infants
• Umbillical cord Liver Right Atrium Right Ventricle OR Left Atrium via foramen ovale
In an infant, if the blood moves to the right ventricle then it will move by way of (blank), cuz lungs arent functional.
What if it moves to the left atrium?
o If it goes to right ventricle -> ductus arteriosus instead of pulmonary artery b/c lungs aren’t yet functional -> joins aorta and goes to rest of body
o If it goes to the left atrium ->l eft ventricle -> aorta
In an infant, are the atria and ventricles the same size?
yes
when does the ductus arteriosus and foramen ovale CLOSE?
at birth
By age (blank), ventricles are twice the size of the atria
1
Heart is more (blank) until age 7
horizontal
What type of women have increased plasma volume by 50% until 30 weeks and returns to normal after delivery?
pregnant
Do pregnant women have increased cardiac output?
By how much?
yes
30-40% and peaks about 30 weeks and returns to normal after delivery
What is significant about heart size in old people?
What is significant about the valves and SA node?
What happens to the myocardium?
decreases unless there is hypertension or heat disease
the left ventricle thickens
can fibrose or calcify
becomes stiff
What will you see on an ECG of an old person?
o Blocks, wave abnormalities, premature systole, left ventricular hypertrophy, or atrial fibrillation
Overall, what can you say about the heart of an older person?
• Efficient at resting levels BUT poor response during stress/exercise
What should you ask your patient if he/she complains about chest pain?
onset and duration character location severity symptoms treatment fatigue cough difficulty breathing loss of consciousness
If a child complains of chest pain what should you look for?
pregnant woman?
old person?
- With children specifically look for fatigue, shortness of breath, joint pain, and preferring to squat instead of sitting
- With pregnant women specifically look for dizziness when standing, shortness of breath (dyspnea), fainting (syncope)
- With old people specifically look for confusion, dizziness, palpitations, coughs and wheezes, chest tightness, leg edema
If a pnt complain of chest pain, ask about PMH for what?
Cardiac surgery?
Any rhythm disorder of the heart?
Any rheumatic fever or swollen joints?
Any chronic illnesses such as hypertension, hyperlipidemia, diabetes, thyroid problems, coronary artery disease, congenital heart issues?
What are common differential diagnoses of chest pain?
Angina Pectoris pressure or choking pain that relays to neck, happens more after strenuous exercise or in the cold, specific time of onset, relief with nitroglycerin
Musculoskeletal history of trauma, vague onset, relief with NSAID’s
Gastrointestinal history of indigestion, vague onset, relief with antacids
When you are inspecting the heart, where do you look for the apical impulse?
chest moves up at 5th intercostal space on left side
• Harder to see when obese or have large breasts
If you cannot find heart sounds then what problems could result?
could be extracardiac problem = problem with pleural or pericardial fluid
You should inspect skin and nail bed for (blank)
cyanosis
What is the normal capillary refill time?
2 seconds
When you palpate, where should you start?
at the apex, move up left border, move towards sternum, move down toward right border
When you palpate, what should you feel for?
apical impulse (if too forceful, could be increased cardiac output or left ventricle hypertrophy)
If the apical impulse is displaced to the right, it may be signs of (blank)
dextrocardia
If the apical impulse is faint it may be a sign of (blank)
pericardial or pleural fluid problem
What is the apical impulse indicative of?
S1
What else should you palpate for other than the apical impulse?
Feel for the thrill -> fine, rushing vibration in 2nd intercostal space
• If you can feel it = aortic or pulmonary stenosis, pulmonary hypertension, or atrial septal defect
While feeling for the apical impulse, you should also feel for pulse in (blank)
carotid artery (medial neck region)
Why do you percuss the heart?
to find the borders of heart (sound will change to resonant to dull at border)
What 5 areas should you ausucultate?
- aortic valve (2nd right intercostal space along sternum)
- Pulmonic Valve second left intercostal space along sternum
- Second pulmonic area third left intercostal space along sternum
- Tricuspid area fourth left intercostal space along sternum
- Mitral area fifth left intercostal space along midclavicular line
It is always louder at the (blank) of the heart and softer at the (blank)
apex, base
This is for which S?
Ask patient to hold breath upon expiration
• Louder at apex, quieter at base
• Possible for splitting to occur (because there are 2 valves – tricuspid and mitral) but RARE
• If too loud blood velocity is increased
o Anemia, fever, hyperthyroidism, anxiety, exercise
• If too soft possible blockage
o Increased overlying fat, systemic or pulmonary Htn, fibrosis and calcification of mitral valve
S1
This is for which S?
Ask patient to inhale deeply and try to hear split S2 (best heard in pulmonic valve area)
o With the splitting, A2 (aortic) is before P2 (pulmonic)
o Easier to detect in young patients
o Possible Pathology
Wide Splitting delay in split = pulmonic stenosis or pulmonary Htn
Fixed Splitting unaffected by respiration = septal defects
Reversed Splitting P2 before A2 = heard during expiration instead of inspiration
• Louder at base, quieter at apex
• If too loud
o Systemic or pulmonary Htn
• If too soft
o Increased overlying fat, aortic or pulmonic stenosis
S2
This is for which S’s
Here it sometimes, don’t hear it other times = it just depends
• S3 is very quiet b/c it is atrium passively filling the ventricle
o Sounds like Ken-TUCK-y
• S4 is the atrium forcefully contracting to fill ventricle
o Often times confused with a Split S1 because it occurs at the end of diastole (right before S1 is supposed to occur)
o Sounds like TEN-nes-see
o When loud ALWAYS indicative of pathology
• Both are louder in left lateral decubitus position
For S3 and S4
What occupies both systole and diastole • 3 distinct components contribute to sound: o Atrial systole o Ventricular systole o Ventricular diastole More distinct at APEX Cause? • Inflammation of pericardial sac causes roughening of parietal and visceral surfaces
pericardial friction rub
CLICK sound early in diastole
More distinct at APEX
Prosthetic mitral valve
CLICK sound early in systole
prosthetic aortic valve
(blank) is a term used to define the failure of the mitral and tricuspid valvs or the pulmonic and aortic valves to close simulataneously.
splitting
fixed splitting is unaffected by (blank)
respiration
fixed splitting is unaffected by (blank)
respiration
paradoxic splitting occurs when closure of the aortic valve is (blank)
delayed
paradoxic splitting occurs when closure of the aortic valve is (blank)
delayed
o For the valves, sound depends on material used for prosthetic
Animal tissue =
Pacemaker = NO SOUND
QUIET
o For the valves, sound depends on material used for prosthetic
Animal tissue =
Pacemaker = NO SOUND
QUIET
What are heart murmurs?
Prolonged heart sounds that usually sound like “whooshing”
Could have backflow of blood due to faulty valve regurgitation
What are heart murmurs?
Prolonged heart sounds that usually sound like “whooshing”
Could have backflow of blood due to faulty valve regurgitation
What is the most common cause of heart murmurs?
anatomic disorder of heart valves
What is the most common cause of heart murmurs?
anatomic disorder of heart valves
What are these causes of?
• 1) Increased speed of blood flow (could be from anemia or pregnancy)
• 2) Structural defects that reroute blood flow (myocardial septum defect)
• 3) Weak contraction
• 4) Blockage in blood flow of vessels near heart (such as aorta)
• 5) Aortic valve stenosis
• 6) Ruptured chordae tendineae in mitral valve
• 7) Forceful left ventricle contraction (more common in children)
• 8) Obstructive diseases in cervical arteries atherosclerotic carotids OR fibromuscular hyperplasia
heart murmurs
What are these causes of?
• 1) Increased speed of blood flow (could be from anemia or pregnancy)
• 2) Structural defects that reroute blood flow (myocardial septum defect)
• 3) Weak contraction
• 4) Blockage in blood flow of vessels near heart (such as aorta)
• 5) Aortic valve stenosis
• 6) Ruptured chordae tendineae in mitral valve
• 7) Forceful left ventricle contraction (more common in children)
• 8) Obstructive diseases in cervical arteries atherosclerotic carotids OR fibromuscular hyperplasia
heart murmurs
What is the difference between benign and innocent heart murmurs?
innocent, particularly in children or young athletes = NO structural anomaly at all even though benign may have one
What is the difference between benign and innocent heart murmurs?
innocent, particularly in children or young athletes = NO structural anomaly at all even though benign may have one
How are heart murmurs characterized?
1) Timing and Duration ex: Early systolic = begins with S1, decrescendos, and ends before S2
2) Pitch can be high, medium, or low High pitch = use diaphragm, low pitch = use bell
3) Intensity 5 Grades of “loudness”
4) Pattern Crescendo or decrescendo
5) Quality what does it sound like?
6) Location and Radiation sound usually transmitted in direction of blood flow from the affected valve!
7) Respiratory does breathing change it?
How are heart murmurs characterized?
1) Timing and Duration ex: Early systolic = begins with S1, decrescendos, and ends before S2
2) Pitch can be high, medium, or low High pitch = use diaphragm, low pitch = use bell
3) Intensity 5 Grades of “loudness”
4) Pattern Crescendo or decrescendo
5) Quality what does it sound like?
6) Location and Radiation sound usually transmitted in direction of blood flow from the affected valve!
7) Respiratory does breathing change it?
• Narrowed mitral valve = obstructed flow from left atrium to left ventricle
• Often seen with mitral regurgitation
• Causes? Rheumatic fever OR cardiac infection
• Findings
o Low-frequency diastolic
o Heard at apex
o Palpable thrill
o S1 is increased makes sense because this valve needs to close to produce S1 sound!
mitral stenosis
• Narrowed mitral valve = obstructed flow from left atrium to left ventricle
• Often seen with mitral regurgitation
• Causes? Rheumatic fever OR cardiac infection
• Findings
o Low-frequency diastolic
o Heard at apex
o Palpable thrill
o S1 is increased makes sense because this valve needs to close to produce S1 sound!
mitral stenosis
• Narrowed aortic valve due to calcification
• Causes? Rheumatic heart disease OR atherosclerosis
• Findings
o Mid-frequency midsystolic
o Heard at left sternal border
o Palpable thrill
o S2 is very quiet or absent make sense because this valve needs to close to produce S2 sound and it can’t close properly due to calcification
aortic stenosis
• Narrowed aortic valve due to calcification
• Causes? Rheumatic heart disease OR atherosclerosis
• Findings
o Mid-frequency midsystolic
o Heard at left sternal border
o Palpable thrill
o S2 is very quiet or absent make sense because this valve needs to close to produce S2 sound and it can’t close properly due to calcification
aortic stenosis
• Fibrous ring inferior to aortic valve • Can become worse with time • HARD to differentiate this from aortic stenosis • Findings o Fills systole o Heard at apex o Palpable thrill o Multiple waves felt at apical impulse o Split S2, hear S3 and S4
Subaortic Stenosis
• Fibrous ring inferior to aortic valve • Can become worse with time • HARD to differentiate this from aortic stenosis • Findings o Fills systole o Heard at apex o Palpable thrill o Multiple waves felt at apical impulse o Split S2, hear S3 and S4
Subaortic Stenosis
• Narrowed pulmonic valve • Cause? Congenital! • Findings o Mid-frequency Systolic o S1, ejection click, soft or absent S2 o Palpable thrill o Radiates into neck
pulmonic stenosis
• Narrowed pulmonic valve • Cause? Congenital! • Findings o Mid-frequency Systolic o S1, ejection click, soft or absent S2 o Palpable thrill o Radiates into neck
pulmonic stenosis
• Narrowed tricuspid valve due to calcification
• Causes? Rheumatic heart disease OR congenital OR endocardial fibroelastosis (thickening of heart chambers b/c of too many elastic fibers = RARE)
• Findings
o Diastolic
o Resembles mitral stenosis BUT louder on inspiration
o Palpable thrill over right ventricle
tricuspid stenosis
• Narrowed tricuspid valve due to calcification
• Causes? Rheumatic heart disease OR congenital OR endocardial fibroelastosis (thickening of heart chambers b/c of too many elastic fibers = RARE)
• Findings
o Diastolic
o Resembles mitral stenosis BUT louder on inspiration
o Palpable thrill over right ventricle
tricuspid stenosis
• Incompetent mitral valve = backflow from left ventricle to left atrium
• Causes? Rheumatic fever, myocardial infarction, rupture of chordae tendineae (small tendons that hold heart valves in place)
• Findings
o High-frequency Holosystolic = hear it throughout whole systole = after S1 until S2
o VERY loud = may mask S2 sound!
o Heard best at apex, radiates to left axillary region
mitral regurgitation
• Incompetent mitral valve = backflow from left ventricle to left atrium
• Causes? Rheumatic fever, myocardial infarction, rupture of chordae tendineae (small tendons that hold heart valves in place)
• Findings
o High-frequency Holosystolic = hear it throughout whole systole = after S1 until S2
o VERY loud = may mask S2 sound!
o Heard best at apex, radiates to left axillary region
mitral regurgitation
• Efficient in early systole BUT prolapses into atrium in late systole = some blood flows back into left atrium!
• Can become more severe and lead to mitral regurgitation
• Findings
o LATE systolic
o Often preceded by “clicks”
o Heard best at apex when patient is UPRIGHT, not supine
mitral valve prolapse
• Efficient in early systole BUT prolapses into atrium in late systole = some blood flows back into left atrium!
• Can become more severe and lead to mitral regurgitation
• Findings
o LATE systolic
o Often preceded by “clicks”
o Heard best at apex when patient is UPRIGHT, not supine
mitral valve prolapse
• Incompetent aortic valve = backflow from aorta to left ventricle
• Causes? Rheumatic heart disease, Marfan syndrome, cardiac trauma, syphilis o.O
• Findings
o High-frequency early diastolic
But can also hear low-frequency version = Austin-Flint murmur
o Heard best at apex when patient is sitting upright and leaning forward
Aortic Regurgitation
• Incompetent aortic valve = backflow from aorta to left ventricle
• Causes? Rheumatic heart disease, Marfan syndrome, cardiac trauma, syphilis o.O
• Findings
o High-frequency early diastolic
But can also hear low-frequency version = Austin-Flint murmur
o Heard best at apex when patient is sitting upright and leaning forward
Aortic Regurgitation
• Incompetent pulmonic valve = backflow from pulmonary artery to right ventricle
• Causes? Pulmonary hypertension OR bacterial endocarditis
• Findings
o Almost impossible to distinguish from aortic regurgitation with just physical exam
pulmonic regurgitation
• Incompetent pulmonic valve = backflow from pulmonary artery to right ventricle
• Causes? Pulmonary hypertension OR bacterial endocarditis
• Findings
o Almost impossible to distinguish from aortic regurgitation with just physical exam
pulmonic regurgitation
• Incompetent tricuspid valve = backflow from right ventricle to right atrium
• Causes? Pulmonary hypertension, bacterial endocarditis, cardiac trauma, or congenital
• Findings
o Holosystolic just like mitral regurgitation!
How to differentiate?
• Heard at lower left sternal border rather than apex
• Look for pulmonary hypertension by feeling an impulse over second left intercostal space
• ALSO P2 (part of split S2) should be accentuated to try and compensate
Tricuspid Regurgitation
• Incompetent tricuspid valve = backflow from right ventricle to right atrium
• Causes? Pulmonary hypertension, bacterial endocarditis, cardiac trauma, or congenital
• Findings
o Holosystolic just like mitral regurgitation!
How to differentiate?
• Heard at lower left sternal border rather than apex
• Look for pulmonary hypertension by feeling an impulse over second left intercostal space
• ALSO P2 (part of split S2) should be accentuated to try and compensate
Tricuspid Regurgitation
if an infant has right sided heart failure it will show signs of an (blank)
enlarged liver that is pushed inferiorly
if an infant has right sided heart failure it will show signs of an (blank)
enlarged liver that is pushed inferiorly
apical impulse shifted to right
diaphragmatic hernia
apical impulse shifted to right
diaphragmatic hernia
murmurs and tachycardia are common for the first 48 hours of infants lifes, they are typicall (blank)
systolic
murmurs and tachycardia are common for the first 48 hours of infants lifes, they are typicall (blank)
systolic
apical impulse shifted to right
dextrocardia
apical impulse shifted to right
dextrocardia
in, infants S2 has a high pitch and splitting is common, S3 and S4 can be heard … T or F
T
in, infants S2 has a high pitch and splitting is common, S3 and S4 can be heard … T or F
T
This is normal in who?
Sinus arrhythmia fast HR upon inspiration, slow HR upon expiration = NORMAL
Heart rates can change quickly with stress or temperature change
Children
This is normal in who?
Sinus arrhythmia fast HR upon inspiration, slow HR upon expiration = NORMAL
Heart rates can change quickly with stress or temperature change
Children
Does heart rate decrease or increase with age?
decrease
Does heart rate decrease or increase with age?
decrease
Most heart murmurs in children result from what?
congenital problems or rheumatic fever
Most heart murmurs in children result from what?
congenital problems or rheumatic fever
Who is this heard in?
Increased blood volume and heart rate
• Hear split S1 and S2, along with S3 (late in pregnancy) but NO S4
Heart is shifted upwards so apical impulse is also shifted upwards
Systolic murmurs are common in the pulmonic area
Should NOT see cyanosis
pregnant women
Who is this heard in?
Increased blood volume and heart rate
• Hear split S1 and S2, along with S3 (late in pregnancy) but NO S4
Heart is shifted upwards so apical impulse is also shifted upwards
Systolic murmurs are common in the pulmonic area
Should NOT see cyanosis
pregnant women
Who am I describing? Try not to make them change positions to often Heart Rate = Low 40’s to low 100’s Apical impulse is harder to find S4 is common!
old people
Infection of endothelial layer of heart and valves
Pathology More common with valve defects OR when on IV drugs
Symptoms fever, fatigue, murmur, CHF
Findings Neurologic dysfunction, Janeway lesions (small hemorrhaging on palms and soles), Osler nodes (septic emboli on tips of fingers and toes)
bacterial endocarditis
Decrease in pulmonary or systemic circulation
Pathology -> less flow to tissues, left or right sided, when diastolic -> because of too much glycated collagen = ventricles can’t dilate = happens with older diabetics that has not been well controlled
Symptoms -> fatigue, shortness of breath, edema
Findings ->Systolic = narrow pulse pressure, diastolic = wide pulse pressure
congestive heart failure
Inflammation of pericardium
Pathology May lead to cardiac tamponade
Symptoms Sharp chest pain aggravated by movement
Findings Hear a friction rub
pericarditis
Too much fluid in the pericardial sac
Pathology hard for heart to relax, impairs access of blood into the heart, caused by pericarditis or trauma
Symptoms anxiety, chest pain, shortness of breath, discomfort when moving, lightheadedness (syncope), pale skin, rapid breathing, palpitations, edema!
Findings Beck’s triad (heart sounds are muffled, hypotension, jugular venous distention)
cardiac tamponade
Enlargement of right ventricle b/c of pulmonary malfunction
Pathology chronic, usually caused by COPD = leads to pulmonary Htn = stress on right ventricle = hypertrophy = BAD!
Symptoms fatigue, cough
Findings wheezes and crackles, distended neck veins, cyanosis, loud S2
Cor pulmonale
Ischemic necrosis caused by blockage in flow to myocardium
Pathology usually affects left ventricle, caused by atherosclerosis and thrombosis
Symptoms Deep pain that radiates to neck, jaw, and arm, can be mild in older patients = bad because it goes unnoticed!
Findings Dysrhythmias, S4 is present, distant heart sounds
myocardial infarction
Inflammation of the myocardium
Pathology results from infectious agents, toxins, or autoimmune disorders such as amyloidosis
Symptoms fatigue, fever, palpitations, shortness of breath
Findings cardiac enlargement, murmurs, tachycardia
myocarditis
Problem with conduction of nerve impulses throughout heart
Pathology Can be ischemic, infiltrative, or rarely neoplastic, can be caused by certain drugs (ex: antidepressants)
Symptoms transient weakness, syncope (fainting), rapid or irregular heartbeat
conduction disturbances
Syncope is caused by what?
CANADA Cardiac (valve stenosis) Arteriovenous Nervous (autonomic problem) Anemia Drugs (alcohol, poisons, and diabetes as well) Altitude
o Atrial contraction: ventricular contraction 4:1 (should be 1:1) =too much contraction
atrial flutter
slow heart rate between 50 and 60 bpm -> not necessarily a problem
sinus bradycardia
irregular atrial contraction
atrial fibrillation
slow hear rate b/c disruption of conduction signal between atria and ventricles
heart block
o Usually paroxysmal (transient) and due to some stimulus to the atria that is separate from the SA node high heart rate
atrial tachycardia
o High heart rate (>200 bpm), usually suggestive of heart failure = BAD prognosis
ventricular tachycardia
o Irregular ventricular contraction = BAD prognosis = may precede sudden death
ventricular fibrillation
We’re back to the overall 20 abnormalities!
Arrhythmia caused by malfunction of SA node
Pathology secondary to hypertension, atherosclerosis, or rheumatic heart disease
Symptoms fainting, dizzy, seizures, palpitations
Findings Dysrhythmias as seen above! Can lead to CHF
sick sinus syndrome
4 cardiac defects ventricular septal defect, pulmonic stenosis, dextroposition of aorta, right ventricular hypertrophy
Pathology need surgical correction after first spell
Symptoms dyspnea (shortness of breath), exercise intolerance, poor growth, can have SPELLS (paroxysmal dyspnea, loss of consciousness, central cyanosis)
Findings systolic murmur, if not treated can lead to clubbing of fingers and toes, precordial prominence
tetralogy of fallot (infants and children only)
Infants and children ONLY
Opening between left and right ventricles
Pathology 30-50% close on their own within first 2 years of life
Symptoms recurrent respiratory infections, if large VSD poor breathing and growth, can lead to CHF
Findings arterial pulse is small, holosystolic loud murmur
Ventricular septal defect (VSD) Infants and children
Infants and children ONLY
Failure of ductus arteriosis to close at birth
Pathology blood destined for pulmonary arteries goes to aorta too = stress on right ventricle
Symptoms if small, no symptoms. If large, dyspnea (shortness of breath) when exerted
Findings harsh, continuous murmur, wide pulse pressure
patent ductus anteriosis
Infants and children ONLY
Congenital defect in division between left and right atria
Symptoms usually asymptomatic but possible for adults to develop CHF
Findings brief diastolic murmur, wide split S2
atrial septic defect
Systemic connective tissue disease occurring after STREPTOCOCCAL infection or skin infection
Pathology lots of stuff usually problems with mitral or aortic valve leading to stenosis, most common between age 5 and 15 treatment is antibiotics
Symptoms fever, inflammation of joints, rash, chest pain, palpitations, fatigue, dyspnea
Findings murmurs that usually show mitral or atrial regurgitation, friction rub, CHF
Remember that this is the cause of A LOT of murmurs! Detect early and you’re good
• To differentiate this, run an antibody test for the strep bacteria
Infants and children only!!! Acute rheumatic fever
Infants and children ONLY
Inflammation of arteries throughout the body, including coronary arteries
Pathology affects lymph nodes, skin, and mucous too, usually affects children under age of 5
Symptoms high fever, conjunctivitis (inflammation of eyelids), inflamed lips, lymphadenopathy, erythema (redness of skin), joint pain, tachycardia
Findings diagnosis is made if most of the above symptoms are seen!
kawasaki disease
Caused by deposition of cholesterol and lipids on arterial walls
Pathology leads to thickening of vascular wall = narrowing of lumen = less blood flow
Symptoms angina, dyspnea, palpitations
Findings family history is common, see dysrhythmias and CHF
atherosclerotic heart disease (old people)
OLD PEOPLE ONLY
Already went over this! Leaky mitral valve = blood flow from left ventricle into left atrium
Symptoms dyspnea, edema, decreased exercise tolerance
Findings high pitched murmur radiating to axilla, may hear S3
mitral regurgitation
Old People!
Pain caused by myocardial ischemia
Pathology occurs when your cardiac myocytes are receiving less O2 than they require!
Symptoms pain radiating to neck, jaw, and left arms, dyspnea, fatigue, syncope, diaphoresis (excessive sweating)
Findings not definitive see hypertension, tachycardia, and diaphoresis. Look at risk factors and see if patient has them COPD, HTn, abnormal pulsations
angina
Old People!
Deposition of Amyloid (a fibrillary protein produced by chronic inflammation or a neoplastic disease) into heart
Pathology reduced heart contraction, possible CHF
Symptoms palpitations, edema, fatigue, low exercise tolerance
Findings Arrhythmia, dilated neck veins, hepatomegaly, thickened ventricles
senile cardiac amyloidosis
Old People!
LAST ONE
Thickening and calcification of aortic valve
Usually asymptomatic except for midsystolic murmur
aortic sclerosis
