hemodynamics and physical examination in congenital heart disease azaria jjt rein, md
DESCRIPTION
Hemodynamics and Physical Examination In Congenital Heart Disease Azaria JJT Rein, MD. A Gene, Fetus, Baby, Child and Adult Saga. History of Cardiac Imaging. 3-D ECHOCARDIOGRAPHY 1997 TISSUE VELOCITY IMAGING. New Approaches in Diagnosis. 3 D Imaging. 4 CHAMBERS. Coarctation of the - PowerPoint PPT PresentationTRANSCRIPT
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Hemodynamics and Physical ExaminationIn
Congenital Heart Disease
Azaria JJT Rein, MD
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A Gene, Fetus, Baby, Child and Adult Saga
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History of Cardiac Imaging
1995 3-D ECHOCARDIOGRAPHY1997 TISSUE VELOCITY IMAGING
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New Approaches in Diagnosis
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3 D Imaging
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4 CHAMBERS
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Coarctation
of the Aorta
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Prenatal CardiologyPrenatal Cardiology
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THE FETAL KINETOCARDIOGRAM
a a
FKCG~
ECG
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Interventional Pediatric Cardiology
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Atrial Septal Defect (ASD)
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Fetal Interventions
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Direct Puncture of LVin a Fetus
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"That it will ever come into general use, not withstanding its value, I am extremely doubtful; because its whole hue and character is foreign, and opposed to all our habits and associations.”
"מבלי להמעיט בערכה של צורת בדיקה זו, אני בספק רב אם אי פעם השימוש בה יהפוך
לנחלת הכלל, מפני שכל אופייה ומהותה זרים ומנוגדים להרגלינו ולדרך החשיבה שלנו."
John Forbes, 1821
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CC 2003
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HEMODYNAMICS & PHYSICAL EXAMINATION
- Medical History.- Inspection.- Palpation.- Percussion.- Auscultation.
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Antenatal- Family History.- Fetus.- Mother disease.
Perinatal- Delivery.- APGAR score.- First sign & symptom.
Postnatal...
Medical History
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HEMODYNAMICS & PHYSICAL EXAMINATION
- Medical History- Inspection- Palpation- Percussion- Auscultation
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InspectionHi, I’m
Alfred E. Neuman, you know, from Mad
magazine?
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InspectionWhy, me
worry???
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InspectionWhy, me
worry???
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InspectionYes, we both
have Williams’ syndrome!
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InspectionMe
too!!!
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InspectionWith SVAS, SVPS, PPS
and more!!!
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HEMODYNAMICS & PHYSICAL EXAMINATION
AUSCULTATION
- Heart Sounds.
- Murmur.
- Click/Snap
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Murmur and Hemodynamics
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Flow & PressureTHE SIMPLIFIED BERNOULLI EQUATION
P = 4 VP = 4 V2.
P in mm Hg
V in m/sec.
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Murmur and HemodynamicsMURMUR
LAMINAR FLOW -> TURBULENT FLOW
INCREASED FLOW VELOCITY > 1.5 m/sec
INCREASED PRESSURE GRADIENT> 10 mmHg
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Murmur Characteristics
•Timing•Amplitude•Pitch•Location•Radiation•Response to maneuver
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Murmur CharacteristicsTiming
Systole•Pansystolic•Ejection Type•Exceptions (Late SM, Short SM)
Diastole•Early•Mid
Continuous
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Systolic Murmur
systoleS1 S2
IVC
SEM
PSM
Ejection
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Systolic Ejection Murmur
systoleS1 S2
EjectionIVC
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systoleS1 S2
Pansystolic Murmur
EjectionIVC
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Diastole
S1 S2diastole
mo
FillingIVR
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S1 S2
Early Diastolic Murmur
FillingIVR
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S1 S2
Mid-Diastolic Murmur
FillingIVR
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Continuous ( machinery) Murmur
Aorta
PA
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The Evolving PDA Murmur
1 day
few days
> 1-2 weeks
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The Amplitude of a Murmur
Factors influencing the amplitude grading:- Acoustic energy- Media- Stethoscope- Ears & acoustic nerve- perception
- subjective interpretation
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The Pitch of a Murmur
ΔP Pitch
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Response to Maneuver
Change in loading condition ( pre/ after load).
Change in loading of right & left cardiac chambers.
Change in timing of auscultatory event.
Change in pressure gradient.
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CLICKS & SNAPS
H
HADASSAHPediatricCardiology
Wind Pressure Gradient =
Sail Pliable valve
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Systolic Ejection Click
S1 S2
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S1 S2
Opening Snap
OS
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•Timing•Amplitude
•Pitch•Location•Radiation
•Response to maneuver
Murmur Characteristics
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Auscultation
•Aortic Murmurs•“Downstream”
from Aortic Valve
•RUSB
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Auscultation
•Aortic Murmurs•“Downstream”
from Aortic Valve
•Aortic Stenosis- Radiates to Carotids
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Auscultation
• Pulmonary Murmurs
• “Downstream” from Pulmonary Valve
• LUSB
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Auscultation
• Tricuspid Murmurs
• “Downstream” from Tricuspid Valve
• Manubrium Sterni
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Auscultation
• Mitral Murmurs• “Downstream”
from Mitral Valve• LLSB
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PALPATION
PulsesRateCharacteristics
PrecordiumVolume overloadPressure overloadThrill
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PHYSICAL EXAMINATION IN CHD
- Medical History - Anatomical
- Inspection. Diagnosis.
- Palpation. -Hemodynamic assessment
- Auscultation.
CONCLUSION
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