A low-pressure regurgitant flow across the pulmonic valve, as occurs when the pulmonary arterial pressure is normal, is heard as a brief, decrescendo early diastolic murmur at the upper left sternal border. It is made louder by squatting or inspiration and softer by Valsalva maneuvers or expiration. An S 3 or S 4 may be noted at the left mid-to-lower sternal border because of the presence of right ventricular hypertrophy or failure and is augmented by inspiration. The Graham Steell murmur of pulmonary hypertension is a high-pitched, early diastolic decrescendo murmur noted over the left upper-to-left midsternal area and is a result of high-velocity regurgitant flow
across an incompetent pulmonic valve. The regurgitant flow murmur may be present during the whole of diastole because there is a pulmonary-to-right ventricular pressure gradient throughout this time period. Typically, the murmur occurs in severe pulmonary hypertension when the pulmonary artery systolic pressure is more than 60 mm Hg. The quality of this high-pitched early decrescendo diastolic murmur is identical to that of aortic insufficiency. However, the peripheral manifestations of aortic insufficiency are absent. The associated findings of tricuspid regurgitation are frequently present, that is, prominent JVP with surging V waves, holosystolic murmur at the lower left sternal border (louder with inspiration), and enlarged,
pulsatile liver. b. Discuss the etiology, clinical manifestations, pathophysiology of pericarditis, pericardial effusions, and cardiac tamponade and describe the clinical implications. Pericardial Disorder Etiology Clinical Manifestations Pathophysiology Clinical Implications Pericarditis Acute inflammation of the pericardium. Etiology of acute pericarditis is most often idiopathic or caused by viral infection by coxsackievirus, influenza, hepatitis, measles, mumps, or varicella viruses. It is the most common cardiovascular complication of HIV. Other causes include MI, trauma, neoplasm, surgery, uremia, bacterial infection (TB), connective tissue disease (systemic lupus erythematous and rheumatoid arthritis), or radiation therapy. most individuals describe having several days of fever, myalgias, and malaise followed by sudden onset of severe chest pain that worsens with respiratory movements and with lying down. Although pain may radiate to the back, it is generally felt in the anterior chest and may be confused initially with the pain of acute MI. other S&S dysphagia, restlessness, irritability, anxiety, and weakness, low grade fever, sinus tachycardia. A pericardial friction rub- a short, scratchy, grating sound-may be heard at the cardiac apex and left sternal border and is highly specific for pericarditis. The rub is caused by roughened The pericardial membranes become inflamed and roughened, and a pericardial effusion may develop that can be serous, purulent, or fibrinous. Possible sequelae of pericarditis include recurrent pericarditis, pericardial constriction, and cardiac tamponade.
You've reached the end of your free preview.
Want to read all 41 pages?
- Fall '15
- Spring 2018