Lecture 3 Flashcards
Please describe the heart sounds?
First (Lub) sound
- Caused by closer of mitral and tricuspid valves
- Onset of ventricular systole
Second (Dub) sound
- Caused by closer of the aortic and pulmonary valves
- Onset of ventricular diastole
Please describe S3 heart sound (an extra heart sound)?
S3
- Early diastolic, during rapid ventricular filling phase
- Associated with increased filling pressure and more common in dilated ventricles (heart failure)
- Could be normal in children, young adult and pregnant women
Please describe S4 heart sound (an extra heart sound)
S4
- Late diastolic
- High atrial pressure associated with ventricular hypertrophy. Left atrium must push against stiff LV wall
The characterisation of a cardiac murmur consists of several components, what are these?
Intensity, timing, location, transmission, and quality
Describe the different intensities of a cardiac murmur?
Grade I: Barely audible
Grade II: Soft, but easily audible
Grade III: Moderately loud, but not accompanied by a thrill
Grade IV: Loud ± thrill
Grade V: Very loud with the stethoscope partly off chest ± thrill
Grade VI: Audible with the stethoscope off the chest ± thrill
What is the timing, location and quality of a cardiac murmur?
Timing
- Cardiac murmurs can be described as systolic, diastolic (early, mid or late), or continuous (holo or pan)
Location
- Determine the point at which the murmur is the loudest
Quality
- Crescendo, decrescendo
What are the common cardiac murmurs heard?
Aortic stenosis –> Midsystolic (crescendo-decrescendo)
Mitral regurgitation –> Pansystolic (plateau)
Aortic regurgitation –> Early diastolic (decrescendo)
Mitral stenosis –> Middiastolic (crescendo)
In a ROS for a patient who you expect has a heart condition, what questions should you ask?
- Chest pain/heaviness (check if it is exertional)
- Dyspnoea (check if it is exertional)
- Palpitations
- Ankle swelling
- Syncope
- Leg pain
- Sputum
- Indigestion (dyspepsia)
- Systemic symptoms
- Alleviation/Exacerbation
How would you perform a physical examination for a patient who you suspect has a heart condition?
Inspect - Hands - Face - Chest - Limbs Palpate - Heart - PVS Auscultate
What lab tests do you send you patient for, if you suspect they have a heart condition? Biochemical markers
Biochemical markers
- Creatine Kinase (CK)
- CK-MM: Skeletal and Cardiac muscle
- CK-MB: Cardiac, Skeletal
- CK-BB: Neuronal tissue, smooth muscle, thyroid, lung
- Cardiac Troponin (cTn) – highly specific and sensitive
- cTnI
- cTnT
- cTnC
- Myoglobin
- Elevates very rapidly
- Lack of specificity
- Lactate dehydrogenase (LDH)
- Aspartate Aminotransferase (AST)
List some common disorders of the cardiovascular system ?
- Congenital heart defects
- Hypertension
- Atherosclerosis
- IHD – Angina, MI
- CHF
- Arrhythmias
- DVT
- Aneurysm
- Raynaud’s
- Disease = primary Raynaud phenomenon
- Syndrome = secondary Raynaud phenomenon
- Vasculitis
- Temporal arteritis
Please explain congenital heart defects?
Maternal infection or exposure to drugs or toxins may cause congenital heart disease
- Maternal rubella infection is associated with PDA, pulmonary valvular and/or artery stenosis, and ASD
- Maternal alcohol misuse is associated with septal defects, and maternal lupus erythematosus with congenital complete heart block
What Genetic or chromosomal abnormalities cause congenital heart defects?
- Down’s syndrome (Trisomy 21) – septal and valvular defects
- Turner’s syndrome (45, XO) – CoA
- Marfan’s syndrome
- DiGeorge’s syndrome (deletion in chromosome 22q)
Please describe early cyanosis (blue baby)?
Right to left shunt
- Tetralogy of fallot (most common of early cyanosis)
- Transposition of great vessels
Please describe Acyanotic or Late cyanosis (blue kids)
Left to right shunt
- VSD (most common congenital heart defect)
- ASD (loud S1, wide, fixed split S2)
- PDA (May closes with indomethacin)
- Without shunt
- CoA
What is cyanosis?
- A dusky blue discoloration, when the capillary oxygen saturation is less than 85%
- Peripheral
- At the extremities
- Central
- At the mucous membranes and also periphery
Please describe the difference between peripheral and central cyanosis?
Central cyanosis
- Shunting of deoxygenated venous blood into the systemic
circulation, as in the presence of a right-to-left heart shunt
Peripheral cyanosis
- Associated with peripheral vasoconstriction and stasis of blood in the extremities leading to increased peripheral oxygen extraction. Such conditions include
Congestive heart failure, circulatory shock, exposure to cold temperatures and abnormalities of the peripheral circulation, e.g. Raynaud’s phenomenon
- Cold hands and feet
What are the blood pressure regulators?
Short term - Vasoconstrictors - Baroreceptors - Chemoreceptors - CNS - Hormones Mid-term - Renin-Angiotensin-Aldosterone System (RAAS) Long term - Erythropoietin
Know hypertension gradings
DO IT DUDE!
