Lecture 3+4 Flashcards
pericarditis
inflammation of the pericardium
cause:
infection, renal failure, MI, post-surgical
pericardial friction rub
A resulting sound due to roughness of the parietal lining from inflammation
pericardial effusion
the accumulation of excess fluid within the pericardial space
cause:
pericarditis
CT disease
hypothyroidism
cardiac tamponade
rapid large fluid (blood) accumulation in the pericardial space that leads to compression which prevents adequate filling of the chambers
clinical signs: beck’s triad
- hypotension
- distant heart sounds
- distended neck veins
causes:
Stab wound, MI, or Rupture of heart muscle
treatment: pericardiocentesis
paraxiphoid approach: tip of xiphoid, or between xiphoid and left costal margin, angles towards shoulder
apical approach: left 5th or 6th intercostal space
where does the right atrium get blood from?
gets blood from the IVC, SVC, and coronary sinus
left atrium
gets blood from 4 pulmonary arteries
location of aortic valve and where to auscultate
location: posterior to left side of sternum at 3rd intercostal space
Auscultate: right sternal border at 2nd intercostal space
location of pulmonary valve and where to auscultate?
location: left 3rd costal cartilage
auscultate: left costal border at 2nd intercostal space
location of tricuspid valve and where to auscultate
location: behind sternum at 4/5 intercostal space
auscultate: left sternal border at 5th intercostal space
mitral valve location and where to auscultate
location: behind sternum at 4th costal cartilage
auscultate: 5th left intercostal space in midclavicular line
structures supplied by the right coronary A.
right atrium right ventricle SAN AVN interventricular septum
structures supplied by the left coronary A
left atrium and left ventricle
interventricular septum
What is S1 and S2?
S1 (Lub) is the closing of the mitral and tricuspid valve.. systole
S2 (Dub) is the closure of the aortic and pulmonary valve… diastole
What is diastole and systole?
diastole is when the heart is filling with blood and is not contracting (S2 to S1)
systole is the period of contraction (S1 to S2)
The 7 steps of the cardiac cycle
- Arterial systole (diastole)
(S1) - isovolumetric contraction (systole: mitral valve closure)
- rapid ventricular ejection (systole: Aortic valve open)
- reduced ventricular ejection (systole: aortic valve open)
(S2) - isovolumetric ventricular relaxation (diastole: aortic valve closure)
- rapid ventricular filling (diastole: mitral valve open)
- reduced ventricular filling (diastole: mitral valve open)
Electrocardiogram (electrical activity)
P = arterial depolarization
QRS = ventricular depolarization
T = ventricular repolarization
Normal cardiac pressures for LA, LV, and aorta (mmHg)
LA: 12
LV: 130/10
Aorta: 130/90
Normal cardiac pressures for RA, RV, pulmonary A. (mmHg)
RA: 5
RV: 25/5
pulmonary A: 25/10
have lower pressures compared to the left side because the pulmonary system is a low resistance circulation
S1, S2, S3, and S4
origin and location? Normal/Abnormal?
S1: mitral and tricuspid valve closure
loudest at the mitral valve region
normally present
S2: aortic and pulmonary valve closure
loudest at left upper external border
normally present
S3: In early diastole during rapid ventricular filling phase
Can be found in children, young adults, and pregnant
women (can be normal; but not normally present)
Abnormal in adults: Dilated ventricles (more common), increased filling pressure: mitral regurgitation. May lead to heart failure (left ventricular failure)
S4: during late diastole (atrial kick)
best heard at the apex with patient in left lateral decubitus position
abnormal regardless of age: high atrial pressure, ventricular hypertrophy, stiff left ventricular wall
splitting patterns of S2
- wide-splitting: This is due to a delay of RV emptying
pulmonic stenosis - fixed-splitting: produces a great delay in the pulmonic valve
arterial septal defect - paradoxical splitting: delay aortic valve closure
aortic stenosis
systolic murmurs
- aortic stenosis
crescendo and decrescendo
usually due to age-related calcification - Mitral regurgitation
high-pitch “blowing murmur” (loudest in apex)
due to rheumatic fever and/or ischemic heart disease - mitral valve prolapse (most frequent)
late systolic crescendo (loudest just before S2 at apex)
due to rheumatic fever and/or Marfan syndrome and/or ehlers-danlos syndrome - Tricuspid regurgitation
high-pitched “blowing murmur” in tricuspid area
due to right ventricle dilation and rheumatic fever - ventricular septal defect
harsh sound, loudest in tricuspid area
Diastolic murmur
- Aortic regurgitation
high-pitched blowing early diastolic
causes: aortic root dilation, bicuspid aortic valve, endocarditis, rheumatic fever - mitral stenosis
delayed rumbling
caused by sequela of rheumatic fever
continuous mumur
patent ductus arteriosus:
machine-like murmur
best heard in the left infraclavicular area (loudest at S2)
causes: congenital rubella / prematurity
