Chapter 23 PHYSIO: Heart Sounds; Dynamics of much as in aortic stenosis

Valvular and Congenital Heart Defects 2. Atrial volume leads to atrial

AFGC, MD 2023 fibrillation
3. R. ventricle pressure could lead
HEART SOUNDS to r. vent. failure
1st heart sound (“lub” sound) 4. LAP could cause pulmonary edema
- A-V valves close 5. L. ventricle normal
- Louder than second sound
- Low pitch
nd
2 heart sound (“dub” sound)
- Aortic and pulmonary valve closes
3rd heart sound
- Very low pitch
- Caused by inrushing of blood into ventricles II. Mitral regurgitation
4th heart sound A. Blowing murmur heard throughout systole
- Atrial contraction late in diastole – high pitch
- Hard to hear with stethoscope except in B. Best sound heard over l. atrium
hypertensive patients with a thick left ventricle – must be heard over l. ventricle if too deep.
C. Hemodynamics:
Dynamics of Streptococcal Damage to Heart Valves 1. LAP can cause pul. edema
2. CO falls more if r. heart fails
3. L. atrial volume can cause atrial fibrillation

III. Aortic stenosis

A. 80% of patients are male
B. Diamond shaped - or crescendo
ETIOLOGY OF MURMURS and decrescendo - (some are fast ejection murmurs)
A. Stenotic damage usually initiated by C. Pressure in vent. may reach 400mm Hg (vent.
streptococci Hypertrophy)
B. Streptococcus release M antigen D. Very loud - can be felt with hand if severe
C. Antibody releases complement E. Repair with prosthetic valve or porcine valve (as in all
D. Mitral valve- most common murmurs)
E. Aortic valve- second most common F. Hemodynamics:
1. L. ventricular hypertrophy
Results of Heart Valve Disease 2. Repair of valve sometimes leads
A. Stenosis of valve to regurgitation
B. Destruction of valve => regurgitation or insufficiency 3. Angina pain in severe stenosis
4. High mortality in surgery
I. Mitral stenosis 5. Chronic in blood vol.
A. Murmur heard in last 3rd of diastole
B. Described as a “thrill” over apex of heart
C. Low rumbling murmur
D. Hemodynamics
1. CO and MAP do not decrease nearly as
IV. Aortic regurgitation Tetralogy of Fallot
A. Blowing murmur - high pitch - Pulmonary artery stenosis or pulmonary valve
B. Listen over l. ventricle for best sound stenosis
C. Short murmur means blood flows back rapidly and is - Aorta displaced over septum
more severe - Equal systolic pressure in both ventricles
D. May have stroke vol. of 300ml with 70ml going to - Enlarged rt. Ventricle
periphery and 230 leaking back - Blue baby - blood does not flow through lungs
E. Hemodynamics of aortic regurgitation enough
1. Aortic diastolic pressure decreases rapidly - Surgery very helpful
2. Filling of ventricle can compress inner parts
of heart and coronaries
3. L. ventricular hypertrophy

DIAGNOSIS OF MURMURS
A. ECG axis deviation showing
hypertrophy
B. Echocardiogram
C. X-ray
D. Catheterization
E. Stethoscope or phonocardiogram

Patent Ductus Arteriosus

- Can be treated with prostaglandin blocker,
indomethacin
- Blood recirculates through lungs
- Net CO decreases so blood volume and CO
goes back toward normal
- Decrease Cardiac reserve
- Can cause pulmonary Edema
- Left ventricular Hypertrophy
- Right ventricular hypertrophy

Interventricular Septal defect

- Pan systolic murmur unless hole closes during
contraction

Interatrial Septal defect

- Foramen ovale does not close
- 1/3 of people do not have normal fibrotic
closure of foramen ovale, but LAP causes it to
close