Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Quantium Medical Cardiac Output wikipedia , lookup
Rheumatic fever wikipedia , lookup
Cardiac surgery wikipedia , lookup
Electrocardiography wikipedia , lookup
Artificial heart valve wikipedia , lookup
Aortic stenosis wikipedia , lookup
Hypertrophic cardiomyopathy wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
Atrial septal defect wikipedia , lookup
DIFFERENTIAL DIAGNOSIS Hx Patient ASD VSD PDA RHD “heart disease” in childhood Prolonged symptom-free period most children with small defects remain asymptoma-tic frequent URTI Palpitations premature birth, perinatal distress, or perinatal hypoxia may be present (+) upper respiratory tract infection Mitral stenosis easy fatigability occasional chest pain Fatigue Dyspnea on exertion Orthopnea Frequent respiratory infections Symptoms of right ventricular failure In patients with Eisenmenger syndrome, symptoms in adult life consist of exertional dyspnea, syncope and hemoptysis R-L shunt leads to cyanosis, clubbing, and erythorocytosis -dyspnea and cough on exertion -orthopnea and PND -hemoptysis Mitral regurgitation -dyspnea and cough on exertion -orthopnea and PND -ankle edema P.E. Patient ASD VSD PDA RHD Hyposthenic, narrow AP chest diameter Prominent RV impulse loud, harsh, or blowing holosystolic murmur is heard best over the lower LSB in the 3rd or 4th ICS precordial activity is increased Mitral stenosis diastolic thrill at the apex S1 and P2 are accentuated S2 is split or fixed OS of the mitral valve on expiration (+) carvallo's sign Normal JVP and CAP Left lower sternal lift Normal S1 ff. by gr. 3/6 crescendodecrescendo murmur S2 wide with fixed splitting Multiple clicks at apex S1 normal or split, with accentuation of TV closure sound Wide & fixed splitting of the S2 Systolic ejection murmur (heard in pulmonic area) Diastolic rumble across the tricuspid valve Neck vein distention Ascites Edema displaced cardiac apex with a similar holosystolic murmur apical impulse is laterally displaced S1 normal, S2 typically obscured by murmur Continuous machinery-like apical diastolic murmur rumble and third heart Bounding sound (S3) peripheral pulses Mitral regurgitation (+) systolic thrill at the apex holosystolic murmur -(+) S4 ECG Patient ASD VSD PDA RHD Normal sinus rhythm Ostium secundum defects – incomplete right bundle block & right axis deviation May be normal LVH with a larger PDA LVH RVH Incomplete RBBB Diffuse ST-T changes Ostium primum defects – left anterior hemiblock & left axis deviation With larger defects there are various degrees of right axis deviation associated with right ventricular Enlargement CXR Patient ASD Cardiomegaly with multichamber enlargement and pulmonary congestion Shunt vascularity Right (inc. pulm. Ventricular vascular markings) enlargement LAE Right ventricular enlargement PAE Enlargement of the pulmonary artery segment in P-A view VSD Increased pulmonary vascular markings PDA LVE PVE RHD Mitral stenosis -(+) kerley B lines -concentric hypertrophy of left atrium -cephalization -prominent main pulmonary artery and branches -constriction of arteries in the middle and peripheral lung zones Mitral regurgitation -eccentric hypertrophy of the left atrium -LA and LV enlargement -equalization, cephalization -mitral annulus calcification Echo Patient ASD ASD, ostium secundum type Enlargement of RV color flow can Negative-contrast show the image at the site shunting of of defect (saline blood from injection) the left ventricle to Doppler – the right abnormal pressure of left-to-right VSD's can blood flow across result in a the septum shunt from below the tricuspid valve to below the pulmonary valve. Markedly dilated right ventricle with adequate wall motion and contractility with evidence of RV pressure and volume overload Dilated RA w/o thrombus Dilated MPA Severe TR PR Mod. Pul. HPN Reverse E/A across mitral valve VSD PDA RHD LAE Mitral stenosis -mitral orifice <4cm -concentric hypertrophy of left atrium -annular calcifications Continuous flow from the aorta into the main pulmonary artery Mitral regurgitation -eccentric hypertrophy of the left atrium -LA enlargement -hyperdynamic LV -annular calcifications/ LV dyskinesis -ruptured chordae tendineae