cardiac sound S3 in normal in
children and pregnant
auscultation of the heart - Aortic area (what we hear)
systolic murmur (aortic stenosis, flow murmur eg. physiologic murmur, aortic valve sclerosis)
auscultation of the heart - left sternal border (what we hear)
- diastolic murmur: aortic regurgitation, pulmonic regurgitation
- systolic murmur hypertrophic cardiomyopathy
auscultation of the heart - Pulmonic area (what we hear)
systolic ejection murmur: pulmonic stenosis, flow murmur (eg physiologic murmur)
auscultation of the heart - mitral valve (what we hear)
- holosystolic murmur: mitral regurgitation
2. diastolic murmur: mitral stenosis
auscultation of the heart - tricuspid valve (what we hear)
- holosystolic murmur: tricuspid regurgitation, ventricular septal defect
- diastolic murmur: tricuspid stenosis, ASD
ASD auscultation
ASD commonly present with a pulmonary flow murmur (increased flow through pulmonary valve) and a diastolic rumble (increased flow across tricuspid). Blood flow across the actual ASD does not cause murmur (no significant P gradient). The murmur later progress to a louder diastolic murmur of pulmonic regurgitation from dilaton of the pulmonary arterey
auscultation of the heart - aortic regurgitation mumur
high-pitched early long diastolic decrescendo murmur.
auscultation of the heart - mitral stenosis mumur
follows opening snap. Delayed rumbling diastolic murmur
auscultation of the heart - aortic stenosis mumur
crescendo - decrescendo systolic ejection murmur
ejection click MAY be present
aortic stenosis pulse
pulsus parvus et tardus: weak with delayed peak
aortic stenosis is often related to
- age related calcification
- early onset calcification of bicuspid aortic valve
- rarely - Rheumatic heart disease (mitral valve is also involved)
MVP murmur
late systolic crescendo murmur with midsystolic click.
acute pericarditis - presentation
sharp chest pain, aggravated by inspiration and lying supine, relieved by sitting up and leaning forward
acute pericarditis - ECG
- ST-segmented
and/or - PR depression
cardiac tamponade - clinical examination
- Beck’s triad (hypotension, distended neck veins, distant heart sounds)
- increased HR
- pulsus paradoxus
most frequent primary cardiac tumor in children
Rhabdomyomas
kussmual sign - definition / may be seen in
- increasing in JVP on inspiration instead of normal decreasing
1. constrictive pericarditis
2. restrictive cardiomyopathy
3. right atrial or ventricular tumors
4. severe right ventricular failure
BNP blood test
- used for diagnosis of heart failure
2. very good negative predictive value
hypertrophic cardiomyopathy - clinical examination findings
- S4
- Systolic murmur (left sternal border) (loudest with valsava, standing up)
- maybe mitral regurgitation due to impaired mitral valve closure
- paradoxical splitting
hypertrophic cardiomyopathy - treatment
- cessation of high intensity athletics
- non-didydropyridines Ca2+ channel blockers
- β-blockers
- Implantable Cardioverter Defibrillator (ICD) if patient is high risk
hypertrophic cardiomyopathy - pulse
quick rise arterial pulse
restrictive/infiltrative cardiomyopathy - major causes
- sarcoidosis
- amyloidosis
- postradiation fibrosis
- endocardial fibroelastosis
- Loeffler syndrome
- hemochromatosis
- scleroderma
Loeffler syndrome
endomyocardial fibrosis with prominent eosinophilic infiltrate
