Flashcards
pathology
Cards in this deck (32)
- 1Consequences of ventricular hypertrophy1. Left- and right-sided heart failure
2. Angina (primarily LVH)
3. S4 heart sound - 2ventricular hypertrophy:a. Correlates with atrial contraction in late diastole; atrial gallop.
b. Caused by blood entering a noncompliant ventricle
c./ Examples
(1) Concentric LVH in essential hypertension or aortic stenosis.
(2) Concentric RVH in pulmonary hypertension or pulmonary stenosis.
(.i) Volume overload in mitral regurgitation or tricuspid regurgitation.(4) Volume overload in aortic regurgitation or pulmonary regurgitation. - 3Congestive heart Failure (CHF):The heart fails when it is unable to eject blood delivered to it by the venous system.
- 4EpidemiologyMust common hospital admission diagnosis in elderly patients
- 5Locations where heart sounds are best heard do not always correlate with their anatomic location;mitral
valve (MV) is best heard at the apex.
the tricuspid valve (TV) at the left parasternal border.
the pulmonary
valve (PV) at the left second and third intercostal spaces (ICS).
the aortic valve (AV) at the left sternal
border for regurgitation murmurs and right second ICS for ejection murmurs. - 6Cardiac Cycle Relationships with Heart SoundsThe P wave represents atrial depolarization.
the PR interval atrioventricular conduction time.
the QRS
ventricular depolarization.
the T wave ventricular repolarization,
or recovery.
The S, heart sound occurs at
the same time as the QRS complex and marks the beginning of systole, while the S, heart sound occurs after
the T wave and marks the beginning of diastole. - 7Heart Sounds;S1 heart sound corresponds with closure of the MV and TV during systole.The MV closes before the TV.
It is best heard at the apex and corresponds with the carotid/radial pulse.
S, heart sound, caused by the closure of the AV and PV and marks the beginning of diastole. It is best heard at the left second or third ICS. - 8continue...The aortic component (A,) normally precedes the pulmonary component (P2).
- 9—Unlike the S, heart sound, the
Sj splits on inspiration. As the diaphragm descends, it causes a further decrease in negative intrathoracic
pressure, which increases the flow of blood out of the vena cava into the right side of the heart. This causes
flattening of the jugular neck veins. The excess amount of blood in the right side of the heart delays closure
of the PV causing P, to separate away from Aj (see schematic). This physiologic split is best heard over the
PV area. A, and P, become a single sound on expiration as intrathoracic pressure becomes less negative.
An accentuated Aj is heard in essential hypertension (increased pressure causes it to snap shut), while an
accentuated P, is heard in pulmonary hypertension. - 10continue...S3 heart sound, is the most clinically significant extra heart sound.
It is a normal
finding in children and young adults, where it reflects a more energetic expansion and filling of the left
ventricle. However, it is considered a pathologic finding after 40 years of age. It is thought to be due to a
sudden rush of blood entering a volume overloaded left or right ventricle. It Is best heard at the apex with
the patient in the left lateral decubitus position. It commonly occurs with regurgitant types of murmurs
involving any of the valves. It is the first cardiac sign of congestive heart failure, where increased ventricular
volume stretches the MV orTV ring causing volume overload from mitral/tricuspid regurgitation. An
S, heart sound produces a ventricular gallop. - 11continue,..S4, heart sound,
coincides with atrial
contraction in late diastole and the a wave in the jugular venous pulse.It is never a
normal finding and is due to increased resistance to ventricular filling (decreased compliance) following a
vigorous atrial contraction. It is heard best at the apex. Causes of decreased ventricular compliance include
concentric ventricular hypertrophy (left/right) and a volume overloaded ventricle (no more room to expand).
An s4 heart sound and the a wave of a JVP are absent in atrial fibrillation. Presence of an S4, heart sound
produces an atrial gallop. Presence of an S3 and S4, heart sound is called a summation gallop (see schematic)
and sounds like a galloping horse. - 12Heart Murmursmay occur in systole and diastole.They may be caused by structural valve disease (e.g., damage
due to rheumatic fever) or stretching of the valve ring (e.g., volume overload in left- or right-sided heart
failure). - 13murmurs types:1/ functional.
2/ radiating.
Murmurs due to stretching of valve rings are often called functional murmurs. Murmurs often radiate. - 14Wall stress increases gene-controlled sarcomere duplication.Ventricular hypertrophy:
increased afterload causes
concentric hypertrophy. - 15Preload: equivalent to LVEDV.Consequences of
hypertrophy: heart failure,
s4, angina (LVH). - 16S4: blood entering noncompliant ventricle.Ventricular hypertrophy:
increased preload causes
eccentric hypertrophy. - 17Ventricular hypertrophy:Compensatory change related to changes in pressure in the wall of the ventricle.
- 18Pathogenesis of left and right ventricular hypertrophy:1. Sustained pressure in the ventricles increases wall stress.
2. Changes in wall stress produce changes in gene expression.
3. Changes in gene expression lead to duplication of sarcomeres.
4. Changes in wall stress related to an increase in afterload. - 19continue..5. Changes in wall stress related to increased preload.
- 204. Changes in wall stress related to an increase in afterload:Increased afterload produces concentric thickening of the ventricular wall.
- 21Causes of concentric left ventricular hypertrophy (LVH):(1) essential hypertension (most common).
(2) Aortic stenosis.
(3) Hypertrophic cardiomyopathy. - 22Causes of concentric right ventricular hypertrophy (RVH):(1)Pulmonary hypertension.
(2)Pulmonary artery stenosis. - 23Increased preload:1/invokes the Krank-Starling pressure relationship to increase
stroke volume.
2/causes dilation and hypertrophy (eccentric hypertrophy 1 of
ventricular wall. - 24Preload correlates with:left ventricular end-diastolic volume (LVEDV).
- 25Causes of eccentric hypertrophy of the left ventricle:(1) Mitral valve or aortic valve regurgitation
(2)Left-to-right shunting of blood (e.g., ventricular septal defect). - 26Causes of eccentric hypertrophy of the right ventricle:Tricuspid valve or pulmonary valve regurgitation.
- 27Cardiac Cycle Relationships with Heart Sounds:The P wave represents atrial depolarization; the PR interval atrioventricular conduction time; the QRS
ventricular depolarization; and the T wave ventricular re-polarization, or recovery. The S, heart sound occurs at
the same time as the QRS complex and marks the beginning of systole, while the S, heart sound occurs after
the T wave and marks the beginning of diastole. - 28Murmurs and abnormal heart sounds (e.g., S3 and S4,( heart sounds) change their intensity with respirations.this increased intensity happened when the patient takes a deep inspiration and holds the breath for 3 to 5 seconds.
This
is due to the increase in negative intrathoracic pressure drawing blood out of the venous system into the
right side of the heart, hence accentuating the murmur and abnormal heart sound. - 29In contradistinction, left-sided heart murmurs and abnormal heart sounds do not change their intensity with deep inspiration.continue,..
- 30murmurs types:1.Continuous murmurs.
2.Innocent murmurs.
3.Stenosis murmurs.
4.Regurgitant (insufficiency)
murmurs. - 31first murmur:**occur through systole and diastole.
**The most common cause of a continuous murmur
in children is a cervical venous hum.
e.g: A patent ductus arteriosus also produces a continuous murmur. - 32—
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- Flashcards on pathology, created by alice zoldiac on 06/02/2018.
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