CARDIOVASCULAR SYSTEMppt.pptx

Fourth heart sound s4 is low pitched presystolic

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FOURTH HEART SOUND S4 IS LOW PITCHED', PRESYSTOLIC SOUND , PRODUCED IN VENTRICLE DURING 2ND RAPID FILLING PHASE CAUSED DUE TO ATRIAL CONTRACTION. S4 IS NEVER PRESENT IN NORMAL INDIVIDUALS. PRESENCE OF S4 IS ALWAYS PATHOLOGICAL. 78
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28 79
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PRESENCE OF HYPERTROPHIED NONCOMPLIANT VENTRICLE. IN THIS CASE ATRIA HAS TO FORCEFULLY CONTRACT TO FILL THE VENTRICLES: I) VENTRICULAR HYPERTROPHY:- LEFT OR RIGHT VENTRICULAR OUTFLOW OBSTRUCTION (AORTIC STENOSIS) SYSTEMIC OR PULMONARY HYPERTENSION HOCM II) ISCHEMIC HEART DISEASE:- ANGINA PECTORIS ACUTE MYOCARDIAL INFARCTION OLD MYOCARDIAL INFARCTION 80
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EXCESSIVE RAPID LATE DIASTOLIC FILLING DUE TO VIGOROUS ATRIAL SYSTOLE INTO THE VOLUME LOADED VENTRICLE. HYPERKINETIC STATES: ANEMIA THYROTOXICOSIS AVFISTULA AV VALVE INCOMPETENCE HEART BLOCK 81
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28 82 Ans. is 'a' i.e., Ventricular aneurysm [Ref: Harrison 18th/ep. 1827, 17/ep. 1386]
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MURMURS 83
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84
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CONTINUOUS MURMUR A CONTINUOUS MURMUR IS DEFINED AS ONE THAT BEGINS IN SYSTOLE AND EXTENDS THROUGH S2 INTO PART OR ALL OF DIASTOLE. IT NEED NOT OCCUPY THE ENTIRE CARDIAC CYCLE. 85
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CAUSES OF CONTINUOUS MURMUR COMMONLY ASKED IN EXAMS: PATENT DUCTUS ARTERIOSUS SYSTEMIC A- V FISTULA CORONARY A- V FISTULA RUPTURED SINUS OF VALSALVA INTO THE RIGHT SIDE OF HEART COARCTATION OF AORTA (AT THE BACK) 86
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30 87 Ans. is 'a' i.e., Ventricular septal defect with Aortic regurgitation [Ref.-Harrison 18th/e p. 1829; 17h/e p. 1388] Venous hum - • It is an innocent continuous murmur heard over the medial aspect of right supraclavicular fossa d/t blood flow in the jugular vein.
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CAREY COOMBS MURMUR "CAREY COOMBS MURMUR IS SEEN ACUTE RHEUMATIC FEVER " . IN ACUTE RHEUMATIC FEVER MITRAL REGURGITATION OCCURS. IN ADDITION TO THE HOLOSYSTOLIC MURMUR OF MITRAL REGURGITAION, ONE MORE MURMUR IS HEARD DURING THE DIASTOLE . THIS IS THE CAREY COOMBS MURMUR OF ACUTE RHEUMATIC FEVER. 89
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IT OCCURS DUE TO INCREASED FLOW ACROSS THE MITRAL VALVE DURING THE DIASTOLE. IN MITRAL REGURGITATION, THE AMOUNT OF BLOOD COLLECTED IN THE ATRIUM AT THE START OF DIASTOLE IS GREATER THAN USUAL (BECAUSE BLOOD FLOWS IN THE ATRIUM FROM TWO DIRECTIONS, ONE FROM THE GREAT VEINS AND OTHER FROM THE REGURGITANT MITRAL VALVE ). FLOW OF THIS LARGE AMOUNT OF BLOOD ACROSS THE MITRAL VALVE DURING THE DIASTOLE PRODUCES A MURMUR WHICH IS CALLED CAREY COOMB 'S MURMUR. 90
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91 Other conditions which may produce carey coomb 's murmur:- Ventricular septal defect. • Patent ductus arteriosus.
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36 92 Ans. is ‘C' i.e., Can be associated with A.R. [Ref. Harrison 16th/e p. 1310]
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AUSTIN FLINT MURMUR - IT HAS FEATURES VERY SIMILAR TO THOSE OF CAREY COOMB'S MURMUR I.E. LIKE CAREY COOMB MURMUR IT IS DELAYED DIASTOLIC, SOFT PITCHED MURMUR UNLIKE CAREY COOMB 'S MURMUR IT IS - ASSOCIATED WITH AORTIC REGURGITATION AUSTIN FLINT MURMUR IS PRODUCED BY ANTERIOR MITRAL VALVE LEAFLET WHEN BLOOD ENTERS THE LEFT VENTRICLE SIMULTANEOUSLY FROM BOTH THE AORTIC ROUTE AND THE LEFT ATRIUM.
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  • Winter '16
  • jean grey
  • Cardiology, Ans., Constrictive pericarditis

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