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
