CARDIOVASCULAR SYSTEM. General approach Inspection Palpation Percussion Auscultation. Heart murmurs Abnormal heart sounds produced as a result of turbulent blood flow sufficient to produce audible noise. Characteristics:
timing , shape, location, radiation , intensity, pitch and quality.
a- Mid-systolic ejection murmurs
b- late systolic murmurs
c- holosystolic murmurs
a- early diastolic murmurs
b- mid-diastolic murmurs
c- late diastolic murmurs
5 places on the anterior sternum
Refers where the sound radiates
Regle of thumb : sound radiates in the direction of the blood flow:
Grade 5 Very loud, with thrill .May he heard when stethoscope is partly off the chest
is determined by whether it can be auscultated best with the bell or diaphragm of a stethoscope.
Mitral prolapse :systolic murmur with midsystolic click, most frequent valvular lesion in young women
Exercise Murmurs caused by blood flow across normal or obstructed valves (eg, mitral or pulmonic stenosis) become louder with both isotonic and submaximal isometric (handgrip) exercise. Murmurs of mitral (MR) and aortic regurgitation (AR) and ventricular septal defect (VSD) also increase with handgrip exercise.
3 types of Angina :stable , unstable and variant (Prinzmetal’s ).
A 62 –year –old smoker presents complaining of three episodes of severe heavy chest pain this morning .Each episode lasted 3 or 5 minutes , but he has no pain now. He has never had this type of pain
A 43 y/o woman presents with frequent episodes of dull chest chest pain on and off for 8 months .He says the pain wakes him from sleep.
Resting ECG is normal in half of patient with angina pectoris
ECG may show ST-segment depression or T-wave flattening
Obtain cardiac enzymes every 8 hrs for 24 hrs to r/o MI
Exercise stress test can confirm suspected diagnosis of CAD
3-Beta-adrenergic blocking agents
Calcium channel blockers
Other mechanisms can cause AMI:
Early death from AMI can be due to a number of complications:
ECG is important in the evaluation of possible AMI
Heart Failure defined as the inability of the heart to pump blood at a rate that meets metabolic demands. Heart failure can be classified according to:
Right Heart failure
Tamponade is the physiologic result of rapid accumulation of fluid in the in-elastic pericardial sac .Pericardial tamponade impairs cardiac filling and reduces cardiac .
Pulsus paradoxus :decrease by >10 sBP with inspiration
Auscultation may demonstrate distant heart sounds
ECG may show low voltage or electrical alternans
CXR may show enlarged cardial silhouette
Echocardiogram will show large pericardial effusion