心脏杂音cardiacmurmurs(编辑修改稿)

心脏杂音cardiacmurmurs(编辑修改稿)内容摘要：

k and decreased filling of the left ventricle. Systemic embolic events are seen in approximately onethird of patients with atrial fibrillation and mitral stenosis and maybe the presenting event before the diagnosis of mitral stenosis is made. 11/12/02 Lubna Piracha, . 21 Case Studies: A 52 year old female presents with plaints of slowly progressive dyspnea on exertion and an unfortable awareness of pulsations in the neck and chest. On Exam you find the following: Abnormal brisk pulses Wide pulse pressures Quincke’s pulse Head bobbing Pistol shot sounds On auscultation you he r this: 11/12/02 Lubna Piracha, . 22 Physical Exam Review • Early diastolic murmur of regurgitation – blowing, and high frequency, and decrescendo in shape. • Systolic aortic flow murmur • Austin flint murmur 11/12/02 Lubna Piracha, . 23 Echocardiography 11/12/02 Lubna Piracha, . 24 Echocardiography 11/12/02 Lubna Piracha, . 25 Aortic Insufficiency – Acute aortic insufficiency usually due to acute aortic dissection or aortic valve endocarditis usually presents with significant shortness of breath and the murmur maybe minimal and peripheral manifestations maybe diminished. This causes the abrupt introduction of a large volume of blood into a nonpliant ventricle increasing the LV end diastolic and pulmonary venous pressures leading to significant dyspnea. A murmur maybe minimal because the abrupt increase LV diastolic pressure rapidly diminishes the aortic to LV diastolic gradient. 11/12/02 Lubna Piracha, . 26 Aortic Insufficiency – In chronic aortic insufficiency, pensatory left ventricular changes occur over time. The chronic volume overload causes stretching and elongation of myocardial fibers (eccentric hypertrophy)。