Download Heart sounds and intra

Heart sounds and intra-cardiac
pressures.
Heart sounds:
• S1: Due to closure of mitral and tricuspid
valves.
• Softer: Cardiac failure, pericardial effusion,
valvular incompetence
• Louder: Tachycardia, shortened PRinterval, mitral stenosis with still pliable
valve
• S2: Closure of aortic and pulmonary
valves.
• Louder: Systemic and/or pulmonary HT
• Softer: Pericardial effusion, hypotension,
valvular incompetence
Splitting of S1 and S2:
• Normally: Deep inspiration, RV-filling, split
S1: Tricuspid valve closes after mitral
valve. Physiologicl splitting of S1.
• ASD: Fixed splitting of S1
• Electrical disturbances: RBBB, LBBB
Splitting of S2:
• Any condition(s) impairing emptying of LV
or RV.
• Valvular stenosis, pulmonary HT etc
S3:
• Caused by rapid ventricular filling
• Can be normal in the young
• Pathology:
• Valvular incompetence
S4:
• Caused by stiff ventricle
• During atrial contraction
• AF: S4 ? or not
Intra-cardiac pressures:
• Intra-atrial pressure: RA: a,c,v waves on
flebogram: From negative to +8 mmHg
• LA: Also a,c,v waves: Maximum +12
mmHg: Measured by catheter: Swan-Ganz
• Pulmonary capillary wedge pressure:
Clinical application of wedge
pressure:
• Pulmonary edema: Cardiac vs non-cardiac
• Increased wedge pressure=cardiac origin:
• LV-failure or mitral valve: stenosis or acute
incompetence
• LV-failure: Systolic vs diastolic
Intra-ventricular pressures:
• RV: From 0 to 25 mmHg
• LV: From 0 to 125 mmHg
• LV pressure-volume curve
• Diagram on cardiac cycle
• La Place`s law
• Poiseulle`s law
• Study from textbook: Ganong