2006 Final Review of Cardiac Axis PDF

2006 FINAL REVIEW 1 PULMONIC STENOSIS DEFINITION MURMUR narrowing/thickening/obstruction of PV that impedes systolic flow from RV  PV  PA harsh systolic ejection classified by location: murmur ...

2006 FINAL REVIEW 1 PULMONIC STENOSIS DEFINITION MURMUR narrowing/thickening/obstruction of PV that impedes systolic flow from RV  PV  PA harsh systolic ejection classified by location: murmur  subvalvular PS  valvular PS left upper sternal border  supravalvular PS Usually congenital 2 Pulmonic Stenosis 2D & M mode 2D ECHO M-MODE thickened cusps right posterior PV cusp systolic doming evaluate “a” wave dip RVH increased "a" wave depth > = 8 mm  severe PS IVS flattening D-shaped LV RAE later stages  right HF post stenotic PA dilatation 3 DOPPLER acquire peak velocity, max PG, mean PG, & PVA (continuity equation) PVA = (VTIRVOT) (CSARVOT) / (VTIPV) 1) acquire RVOTprox (normal 21 – 35 mm) 2) CWD focus in PV acquire peak VPV & VTIPV SEVERITY SCALE: PS DEGREE PEAK PG PEAK (mmHg) VELOCITY 3) PWD gate in RVOT (m/s) acquire peak VRVOT & VTIRVOT mild PS < 36 64 >4 4 PS PULMONIC REGURGITATION DEFINITION MURMUR incompetent PV permits low-pitched diastolic murmur may increase with inspiration backward diastolic flow from PA  when PH is present, a high-pitched defective PV  RV blowing diastolic murmur may be heard (Graham-Steele Murmur) CAUSES COMPLICATIONS incomplete PV closure usually well tolerated for years IE/veg ? increased risk IE RHD dyspnea congenital anomalies severe PR possible  right HF carcinoid heart disease 5 PR 2D ECHO CFD trivial/mild PR turbulent diastolic flow that travels common backward from PA  closed PV  RVOT anatomic basis/defect RVVO examine PR from all views TV diastolic flutter 6 PULMONIC REGURGITAION PHT SLOPE CW: for PULMONIC Regurgitation PR is antegrade spectral waveform MEASURE PHT SLOPE  PULMONARY HYPERTENSION Pulmonary hypertension (PHTN) begins when tiny arteries in the lungs, called pulmonary arteries, and capillaries become narrowed, blocked or destroyed.. Pulmonary hypertension is classified into five groups Pulmonary arterial hypertension (PAH) Pulmonary hypertension caused by left-sided heart disease Pulmonary hypertension caused by lung disease Pulmonary hypertension caused by chronic blood clots Pulmonary hypertension triggered by other health conditions Pulmonary arterial hypertension (PAH),is also known as primary HTN. The blood vessels in your lungs are narrowed, blocked or destroyed. Pulmonary hypertension caused by left-sided heart disease Mitral stenosis can cause the left atrium to work harder to pump blood through the narrowed valve leading to complications such as backflow and increased pressure in the pulmonary veins, leading (1) RVHto + fluid buildup inRVD eventually the lungs & right HF (2) increased RVP flattens IVS paradoxical wall motion with RVVO  IVS may become round in systole 9 Complications Right-sided heart enlargement and heart failure (cor pulmonale). In cor pulmonale, your heart's right ventricle becomes enlarged and has to pump harder than usual to move blood through narrowed Advancedorinterstitial blocked pulmonary arteries lung disease that has led to severe pulmonary hypertension and pressure overload on the right ventricle, eventually leading to dilation and cor pulmonale (right heart failure due to a pulmonary etiology 10 PULMONARY HYPERTENSION CAN BE CAUSED FROM THE EFFECTS THAT REMODEL THE RIGHT SIDE OF THE HEART SUCH AS TRICUSID REGURGITATION TRICUSPID REGURGITATION CAN INCREASE THE VOLUME AN PRESSURES ON THE RIGHT SIDE OF THE HEART AND IN TURN Pulmonary Acceleration Time & Mid Systolic Notching The Pulmonary Acceleration time (PAT) is the amount of time between the onset of systolic arterial flow and peak velocity. When the pulmonary resistance is high the wave form is abnormal. In severe forms of pulmonary hypertension you will find a mid- systolic notch in the descending portion of the signal. The notch ASSESS THE RV SEE RV ASSESSMENT PPTX  Pulmonary Artery Pressures Normal PA pressure is: 15-25 4-12 SYSTOLI Systolic Pulmonary Artery Pressure DIASTOL C (SPAP): 18-25mmHg / Normal IC 30-40 mmHg / Mild 40-70 mmHg / Moderate >70 mmHg / Severe Pulmonary Artery Acceleration time >120 msec Normal acceleration time 80-100 msec Mild pulmonary hypertension 60-80 msec Moderate pulmonary hypertension 100 BPM Tachycardia The intervals between two P and two R waves are consistent Both the atrial and ventricular rates are between 60 – 100 A P wave proceeds each QRS The PR interval is normal 0.12 – 0.20 seconds The QRS duration is normal between 0.06 – 0.10 second  Sinus Dysrhythmia Heart Rate: Rhythm: 60-100 BPM Sinus Dysrhythmia The Interval between the P-P and the R-R are irregular P waves are normal and in front of every QRS PR Interval is normal 0.12 - 0.20 seconds QRS duration is normal between 0.06 - 0.10 seconds  PLEASE STUDY ALL 2D ANATOMY USE THE POWER POINT IN CLASS 14 52