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Pericardial Friction

Grace Sasso — Fri, 30 Jan 2009 20:41:54 +0000

A pericardial friction rub, also pericardial rub, is an audible medical sign used in the diagnosis of pericarditis. Upon auscultation, this sign is an extra heart sound of to-and-fro character, typically with three components, one systolic and two diastolic. It resembles the sound of squeaky leather and often is described as grating, scratching, or rasping. The sound seems very close to the ear and may seem louder than or may even mask the other heart sounds. The sound usually is best heard between the apex and sternum but may be widespread. Source: Wikipedia

Continuous Murmur

Grace Sasso — Fri, 30 Jan 2009 20:28:49 +0000

Heart murmurs are most frequently organized by timing, into systolic heart murmurs and diastolic heart murmurs. However, continuous murmurs can not be directly placed into either category.These murmurs are due to blood flow from a high pressure chamber or vessel to a lower pressure system. Patent ductus arteriosus. PDA is an abnormal connection between the aorta and the pulmonary artery, which normally should be closed in infancy. Since aortic pressure is higher than pulmonary pressure, a continuous murmur occurs, which is often described as a machinery murmur, or Gibson's murmur.Aortopulmonary window.shunts. Usually a left to right shunt through a small atrial septal defect in the presence of mitral valve obstruction. Source: Wikipedia

Midsystolic Murmur

Grace Sasso — Fri, 30 Jan 2009 20:27:30 +0000

Murmurs are abnormal heart sounds that are produced as a result of turbulent blood flow which is sufficient to produce audible noise. This most commonly results from narrowing or leaking of valves or the presence of abnormal passages through which blood flows in or near the heart. Murmurs are not usually part of the normal cardiac physiology and thus warrant further investigations. However, they sometimes result from harmless flow characteristics of no clinical significance. Murmurs can be classified by seven different characteristics: timing, shape, location, radiation, intensity, pitch and quality. Timing refers to whether the murmur is a systolic or diastolic murmur. Shape refers to the intensity over time; murmurs can be crescendo, decrescendo or crescendo-decrescendo. Location refers to where the heart murmur is auscultated best. There are 6 places on the anterior chest to listen for heart murmurs; the first five out of six are adjacent to the sternum. Each of these locations roughly correspond to a specific part of the heart. The locations are: 2nd right intercostal space, 2nd - 5th left intercostal spaces, and 5th mid-clavicular intercostal space. Radiation refers to where the sound of the murmur radiates. The general rule of thumb is that the sound radiates in the direction of the blood flow. Intensity refers to the loudness of the murmur, and is graded on a scale from 0-6/6. The pitch of a murmur is low, medium or high and is determined by whether it can be auscultated best with the bell or diaphragm of a stethoscope. Some examples of the quality of a murmur are: blowing, harsh, rumbling and musical. Source: Wikipedia

Holodiastolic Murmur

Grace Sasso — Fri, 30 Jan 2009 20:22:32 +0000

Holodiastolic murmurs last from the end of S2 to the beginning of S1. They are associated with incompetence of the semi-lunar valves. Because the pressure gradient between the great arteries and the ventricles gradually falls during diastole, the murmurs fade in intensity and are decrescendo. Blood flow through an incompetent pulmonary valve seldom generates sufficient vibrations for a murmur to be heard at the body surface so, when a holodiastolic murmur is heard, it is almost certainly caused by aortic valve insufficiency. The PMI is over the left base, and the murmur usually radiates ventrally. It may be heard on the right side of the chest also. The character of the murmur can be quite variable. It may be low or high in pitch, and frequently has a musical element. It often has a cooing, rasping, blowing or buzzing nature. The murmur may have a distant quality. In some cases there will be an increase in intensity at the time of atrial contraction, associated with the jet of blood striking the anterior septal leaflet of the mitral valve. Source: http://www.provet.co.uk/equinecardiology/5a68024.htm

Systolic Murmur

Grace Sasso — Fri, 30 Jan 2009 20:19:14 +0000

One of the most frequent pathologic systolic murmurs is due to aortic stenosis. Most commonly, aortic stenosis arises from one of three conditions. A patient may be born with a congenital stenosis, or acquire the stenosis from secondary conditions such as rheumatic heart disease or idiopathic calcification of the valves. Persons born with an abnormal bicuspid valve are particularly susceptible to calcification later in life. The murmur of aortic stenosis is typically a mid-systolic ejection murmur, heard best over the “aortic area” or right second intercostal space, with radiation into the right neck. This radiation is such a sensitive finding that its absence should cause the physician to question the diagnosis of aortic stenosis. It has a harsh quality and may be associated with a palpably slow rise of the carotid upstroke. Additional heart sounds, such as an S4, may be heard secondary to hypertrophy of the left ventricle which is caused by the greatly increased work required to pump blood through the stenotic valve. Because the second heart sound is largely generated by the sudden closing of the aortic valve, a poorly mobile and stenotic aortic valve may cause S2 to become quieter or even absent. Although S2 is normally created by the closure of the aortic valve followed by the pulmonary valve, if the closure of the aortic valve is delayed enough, it may close after the pulmonary, creating an abnormal paradoxical splitting of S2. Aortic stenosis is a progressive disease, with typical symptoms and clinical findings to match its course. A good mnemonic to remember the march of symptoms related to undiagnosed aortic stenosis is ASC, or Aortic Stenosis Complications. One of the early symptoms is Angina, which is usually stable and exertion-related. A more serious and later condition is Syncope, again associated with exercise. Finally, the hypertrophied left ventricle can no longer meet demands, and Congestive heart failure may ensue. On examination, the phase during systole at which the murmur peaks can help to determine the severity of the disease. An early-peaking murmur is usually associated with a less stenotic valve, while a late-peaking murmur has a more severe degree of stenosis. This is because a more stenotic valve takes longer for the ventricle to generate the terrific pressures needed to force the blood past the lesion. Source: The Auscultation Assistant

Normal Heart Sound

Grace Sasso — Fri, 30 Jan 2009 20:17:39 +0000

Normal heart sounds are associated with heart valves closing, causing changes in red blood flow. S1 The first heart tone, or S1, forms the "lubb" of "lubb-dub" and is composed of components M1 and T1. It is caused by the sudden block of reverse blood flow due to closure of the atrioventricular valves, i.e. mitral and tricuspid, at the beginning of ventricular contraction, or systole. When the ventricles begin to contract, so do the papillary muscles in each ventricle. The papillary muscles are attached to the tricuspid and mitral valves via chorda tendinae, which bring the cusps of the valve closed. The closing the inlet valves and prevents regurgitation of blood from the ventricles back into the atria. The S1 sound results from reverberation within the blood associated with the sudden block of flow reversal by the valves. S2 The second heart tone, or S2, forms the "dub" of "lubb-dub" and is composed of components A2 and P2. It is caused by the sudden block of reversing blood flow due to closure of the aortic valve and pulmonary valve at the end of ventricular systole, i.e beginning of ventricular diastole. As the left ventricle empties, its pressure falls below the pressure in the aorta, aortic blood flow quickly reverses back toward the left ventricle, catching the aortic valve leaflets and is stopped by aortic (outlet) valve closure. Similarly, as the pressure in the right ventricle falls below the pressure in the pulmonary artery, the pulmonary (outlet) valve closes. The S2 sound results from reverberation within the blood associated with the sudden block of flow reversal. A split S2 can be associated with several different cardiovascular conditions. Source: Wikipedia

Podcast Possibilities for Nursing - Sound in Portuguese Language

Grace Sasso — Fri, 30 Jan 2009 19:53:50 +0000

This podcast contains a brief description of the possibilities of application of podcasts for nursing education