Causes of Heart conditions
Heart conditions Causes: Book Excerpts
Heart conditions as a complication of other conditions:
Other conditions that might have
Heart conditions as a complication may,
potentially, be an underlying cause of Heart conditions.
Our database lists the following as having
Heart conditions as a complication of that condition:
Heart conditions as a symptom:
Conditions listing Heart conditions
as a symptom may also be potential underlying causes of Heart conditions.
Our database lists the following as having
Heart conditions as a symptom of that condition:
Drug interactions causing Heart conditions:
When combined, certain drugs, medications, substances or toxins may react
causing Heart conditions as a symptom.
The list below is incomplete and various other drugs or substances may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
- Olanzapine and fluoxetine and thioridazine interaction
- Zyprexa and fluoxetine and thioridazine interaction
- Zyprexa Zydis and fluoxetine and thioridazine interaction
- Fluvoxamine Maleate and Cisapride interaction
- Luvox and Cisapride interaction
- more interactions...»
See full list of 34
drug interactions causing Heart conditions
Medical news summaries relating to Heart conditions:
The following medical news items are relevant to causes of Heart conditions:
Related information on causes of Heart conditions:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Heart conditions may be found in:
Causes of Heart conditions: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Heart conditions.
Gallops & Extra Heart Sounds:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- S3 gallop
–Low-frequency diastolic sound following S2, best heard with bell
–May be heard normally in healthy young adults
–The presence of an S3 in a patient over 40 suggests ventricular enlargement, often secondary to chronic mitral regurgitation, decreased left ventricular ejection fraction, elevated left atrial pressure, acute pulmonary edema, or high-output states (e.g., thyrotoxicosis, pregnancy)
–Right ventricular infarct
–Hypertrophic cardiomyopathy
-
S4 gallop
–Low-frequency diastolic sound preceding S1, best heard with bell
–May be normally heard in healthy older adults
–Occurs with hypertensive heart disease, aortic stenosis, hypertrophic cardiomyopathy, pulmonary hypertension, coronary artery disease
-
Midsystolic click
–Most commonly due to mitral valve
prolapse
Summation gallop
–Fusion of S3 and S4 with tachycardia
–Results in a loud diastolic filling sound
-
Pericardial knock
–Early diastolic sound
–Common in constrictive pericarditis (with
or without pericardial calcification)
-
Opening snap
–High-frequency, early diastolic sound
–Most commonly due to mitral stenosis,
tricuspid stenosis, ventricular septal defect, thyrotoxicosis
-
Early systolic ejection sound (ejection click)
–Associated with a bicuspid aortic valve, mitral or tricuspid prolapse, aortic stenosis, prosthetic valves
Tumor “plop” secondary to atrial mycoma
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Irregular Heart Rhythms:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Atrial fibrillation
–One of the most common causes of irregular rhythm
–Narrow QRS complex without organized atrial contraction (no P waves)
–Etiologies include infection, thyrotoxicosis, alcohol, cocaine, amphetamines, myocarditis, pericarditis, hypertensive crisis, ischemia, MI, CHF, hypoxia, PE, hypertension, valvular heart disease
- Atrial flutter with variable block
–Narrow QRS complex
–ECG: “Sawtooth” flutter waves
–Atrial rate is typically 250–350 bpm
–Ventricular rate is usually 1/2 or 1/3 of atrial rate (2:1 or 3:1 block)
–Irregular when variable block is present
–Result of a macro-reentrant circuit in
atrium
-
Premature atrial contractions
-
Paroxysmal atrial tachycardia
- Multifocal atrial tachycardia
–Multiple areas of atrial impulses (more than three P wave morphologies) followed by a narrow QRS complex
–HR ≥ 100 bpm
–Most often seen in patients with lung disease
- Wandering atrial pacemaker
–Multiple areas of atrial impulses (more than three P wave morphologies) followed by a narrow QRS complex
–HR ≤ 100 bpm
–Often occurs in athletes and the very young (increased vagal tone)
-
Premature ventricular contractions
-
Sinus arrhythmia
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Murmurs - Diastolic:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Aortic insufficiency
–Decrescendo murmur heard best at the right second intercostal space -
Austin Flint murmur
–Late diastolic rumble of severe aortic regurgitation
–A result of aortic regurgitation so severe that it causes diastolic mitral regurgitation -
Mitral stenosis
–Opening snap with mid-diastolic rumble, especially in the left lateral decubitus position -
Pulmonary insufficiency
–Accentuated P2 and decrescendo murmur at the left second/third intercostal spaces -
Tricuspid stenosis
–Mid-diastolic rumble at the left sternal
border
–Increases with inspiration
-
Cervical venous hum (disappears upon pressure to the jugular vein)
-
Hepatic venous hum (disappears with epigastric pressure)
-
Mammary souffle (in pregnancy; disappears on compressing breast)
-
PDA (continuous machinery sound)
-
Coronary or pulmonary arteriovenous fistula
-
Coarctation of the aorta
-
ASD with left-to-right shunt
-
Atrial myxoma (“tumor plop”)
-
Pericardial knock (constrictive pericarditis)
-
Bronchial collaterals (congenital heart disease)
-
Anomalous pulmonary venous drainage with left-to-right shunt
-
Pulmonary artery branch stenosis
-
Carey-Coombs murmur (mid-diastolic murmur that occurs in acute rheumatic fever)
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Murmurs - Systolic:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Innocent systolic murmur
–Heard at left sternal border
–Increased when supine
–May be caused by increased flow states
(e.g., anemia, hypovolemia, fever)
-
Still's murmur
-
Mitral valve prolapse
–Midsystolic click with late systolic murmur that shifts with maneuvers
-
Aortic stenosis
–Right side at second intercostal space
–Radiates to carotid arteries
-
Aortic sclerosis
–Right side at second intercostal space
–Midsystole
-
Hyperthyroidism
-
Cervical venous hum
–Disappears with jugular vein pressure
-
Hepatic venous hum
–Disappears with epigastric pressure
-
Mammary souffle
–Occurs in pregnancy
–Disappears upon compression of breast -
Bicuspid aortic valve
–Right side at second intercostal space
–Little radiation
–Possible early diastolic aortic murmur
–Opening sound of aortic valve heard in early systole (systolic ejection click) -
Mitral insufficiency
–Holosystolic murmur heard best in the left lateral decubitus position
–S1 is usually diminished in intensity
-
Tricuspid insufficiency
–Holosystolic murmur at second/third intercostal spaces
-
Endocarditis
–Abrupt onset of new murmur
-
Peripheral pulmonary artery stenosis
-
Atrial or ventricular septal defect
-
Ventricular septal defect
-
Patent ductus arteriosus (continuous machinery sound, second left intercostal space)
-
Coarctation of the aorta
-
Left ventricular outflow tract obstruction
-
Pulmonary artery stenosis
-
Prosthetic valve noises
-
Pericardial friction rubs
-
Papillary muscle dysfunction
-
Pulmonic outflow obstruction
-
Coronary/pulmonary arteriovenous fistula
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Abnormal Heart Sounds:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Abnormal S2 –Most important auscultatory finding; normally, S2 is single on inspiration and narrowly split on expiration, indicating normal pulmonary arterial pressures; difficult to learn, especially in babies with fast heart rates or a screaming child
–Single and/or loud S2: Increased pulmonary artery pressure (large L to R shunt, pulmonary hypertension), also seen in patients with only single outlet from heart (i.e., pulmonary atresia)
–Wide fixed-split S2: ASD, right bundle branch block, post-cardiac surgery
- Systolic murmur
–Up to 50% of children at some point in life
–Mid-systolic/ejection type: S1 and S2 separate from the murmur (lub-shhh-dub), due to flow across semilunar valve, harsh indicates semilunar valve stenosis, whereas low-pitched, vibratory, musical indicates innocent murmur
–Holosystolic/regurgitant murmur: Begins with S1 (which is not clearly heard); always pathologic (mitral valve regurgitation, VSD, subaortic stenosis)
- Diastolic sounds
–Always abnormal
–Early and medium/high pitch murmur indicates semilunar valve insufficiency, low frequency rumbling indicates mitral/tricuspid stenosis
–S3/S4/opening snap: Soft S3 can be normal in healthy children; any sound clearly heard is probably an abnormality of the mitral/tricuspid valve (opening snap) or ventricular filling (S3/S4)
- Continuous murmur
–Murmur in systole that continues into diastole (may not fill entire diastole)
–Venous hum: Low pitched, continuous murmur at both upper sternal borders; disappears when supine; innocent
–Patent ductus arteriosus: Harsh, machinery-like murmur at left upper sternal border (LUSB)
- Systolic ejection click
–High-pitched sound
–Early: Bicuspid aortic valve, loudest at
apex/LLSB, often confused with split S1
–Mid/late: Mitral valve prolapse
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Heart Failure:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
Increased afterload
-
Most common in the neonate due to left-sided obstructive lesions, which present acutely
-
Aortic coarctation is most common
–Increased pulse/BP in right arm
–Decreased pulse/BP in lower extremities
-
Critical aortic stenosis
–Poor pulses, loud murmur
-
Hypoplastic left heart syndrome, aortic arch interruption
Left-to-right shunt lesions
-
Normal cardiac muscle funtion but overcirculation of lungs due to a congenital connection between the right and left side of the heart and low PVR
-
Usually presents at 1–2 months of age
–PVR drops and systemic resistance becomes higher than PV
–Blood shunts from left to right (systemic circulation to pulmonary circulation)
–Pulmonary overcirculation and poor systemic output (poor peripheral perfusion, low urine output)
-
Ventricular septal defect (most common)
-
Atrioventricular septal defect (AV canal, endocardial cushion defect), associated with Down syndrome
-
Patent ductus arteriosus
-
Atrial septal defect (usually asymptomatic)
Intrinsic myocardial disease
-
More common cause of heart failure in older children and adolescents
-
Myocarditis
–Acute inflammation and dysfunction of cardiac muscle, usually postviral
–1/3 remain stable, 1/3 return to normal cardiac function, and 1/3 deteriorate
-
Cardiomyopathy
–Dilated most common, but also hypertrophic and restrictive
–Multiple genetic and metabolic causes, often positive family history, some represent old, “burned-out” myocarditis
-
Myocardial infarction (rare)
–Kawasaki disease
–Congenital coronary abnormalities
(anomalous left coronary artery)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Murmurs:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Aortic insufficiency
Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that’s best heard when the patient sits and leans forward and at the end of a forced held expiration. S2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.
Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that’s best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur — a rumbling, mid-to-late diastolic murmur best heard at the apex — may also occur. Complications may not develop until the patient is between ages 40 to 50; then, typical findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.
Aortic stenosis
With aortic stenosis, the murmur is systolic, beginning after S1 and ending at or before aortic valve closure. It’s harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb’s point), and over the carotid arteries.
If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical, but is absent when the valve is severely calcified. Associated signs and symptoms usually don’t appear until age 30 in congenital aortic stenosis, ages 30 to 65 in stenosis due to rheumatic disease, and after age 65 in calcific aortic stenosis. They may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.
Cardiomyopathy (hypertrophic)
Hypertrophic cardiomyopathy generates a harsh late systolic murmur, ending at S2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S3or S4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.
Mitral insufficiency
Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S2 and commonly an S4. This murmur doesn’t get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.
Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that’s loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.
Mitral prolapse
Mitral prolapse generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.
Mitral stenosis
With mitral stenosis, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S1 or an opening snap — a cardinal sign. It’s best heard at the apex with the patient in the left lateral position. Mild exercise helps make this murmur audible.
With severe stenosis, the murmur of mitral regurgitation may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.
Myxomas
A left atrial myxoma (most common) usually produces a mid- diastolic murmur and a holosystolic murmur that’s loudest at the apex, with an S4, an early diastolic thudding sound (tumor plop), and a loud, widely split S1.Related features include dyspnea, orthopnea, chest pain, fatigue, weight loss, and syncope.
A right atrial myxoma causes a late diastolic rumbling murmur, a holosystolic crescendo murmur, and tumor plop, best heard at the lower left sternal border. Other findings include fatigue, peripheral edema, ascites, and hepatomegaly.
A left ventricular myxoma (rare) produces a systolic murmur, best heard at the lower left sternal border; arrhythmias; dyspnea; and syncope.
A right ventricular myxoma commonly generates a systolic ejection murmur with delayed S2 and a tumor plop, best heard at the left sternal border. It’s accompanied by peripheral edema, hepatomegaly, ascites, dyspnea, and syncope.
Papillary muscle rupture
With papillary muscle rupture — a life-threatening complication of an acute MI — a loud holosystolic murmur can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.
Rheumatic fever with pericarditis
A pericardial friction rub along with murmurs and gallops are heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard are the systolic murmur of mitral regurgitation, a midsystolic murmur due to swelling of the mitral valve leaflet, and the diastolic murmur of aortic regurgitation. Other signs and symptoms include a fever, joint and sternal pain, edema, and tachypnea.
Tricuspid insufficiency
Tricuspid insufficiency is a valvular abnormality that’s characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo’s sign), decreases with exhalation and Valsalva’s maneuver, and is best heard over the lower left sternal border and the xiphoid area. Following a lengthy asymptomatic period, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.
Tricuspid stenosis
Tricuspid stenosis is a valvular disorder that produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva’s maneuver. S1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.
Other causes
Treatments
Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Pulse rhythm abnormality:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Arrhythmias
An abnormal pulse rhythm may be the only sign of a cardiac arrhythmia. The patient may complain of palpitations, a fluttering heartbeat, or weak and skipped beats. Pulses may be weak and rapid or slow. Depending on the specific arrhythmia, dull chest pain or discomfort and hypotension may occur. Associated findings, if any, reflect decreased cardiac output. Neurologic findings, for example, include confusion, dizziness, light-headedness, a decreased LOC and, sometimes, seizures. Other findings include decreased urine output, dyspnea, tachypnea, pallor, and diaphoresis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Cardiac arrhythmias:
Causes
(Professional Guide to Diseases (Eighth Edition))
Arrhythmias may be congenital or they may result from one of several factors, including myocardial ischemia, myocardial infarction, or organic heart disease. Drug ingestion (cocaine, amphetamines, caffeine, beta-blockers, psychotropics, sympathomimetics), drug toxicity, or degeneration of the conductive tissue necessary to maintain normal heart rhythm (sick sinus syndrome) can sometimes precipitate arrhythmias. People with imbalances of blood chemistries or those with a history of cardiac conditions (coronary artery disease or heart valve disorders) are at higher risk for developing arrhythmias.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cardiac tamponade:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Increased intrapericardial pressure and cardiac tamponade may be idiopathic (Dressler’s syndrome) or may result from:
❑ effusion (in cancer, bacterial infections, tuberculosis and, rarely, acute rheumatic fever)
❑ hemorrhage from trauma (such as gunshot or stab wounds of the chest and perforation by catheter during cardiac or central venous catheterization or postcardiac surgery)
❑ hemorrhage from nontraumatic causes (such as rupture of the heart or great vessels or anticoagulant therapy in a patient with pericarditis)
❑ acute myocardial infarction (MI)
❑ end stage lung cancer
❑ heart tumors
❑ radiation therapy
❑ hypothyroidism
❑ systemic lupus erythematosus
❑ uremia.
Cardiac tamponade occurs in 2 of every 10,000 people.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Rheumatic fever and rheumatic heart disease:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Rheumatic fever appears to be a hypersensitivity reaction to a group A beta-hemolytic streptococcal infection, in which antibodies manufactured to combat streptococci react and produce characteristic lesions at specific tissue sites, especially in the heart and joints. Because very few persons (3%) with streptococcal infections ever contract rheumatic fever, altered host resistance must be involved in its development or recurrence. Although rheumatic fever tends to be familial, this may merely reflect contributing environmental factors. For example, in lower socioeconomic groups, incidence is highest in children between ages 5 and 15, probably as a result of malnutrition and crowded living conditions. This disease strikes generally during cool, damp weather in the winter and early spring. In the United States, it’s most common in the northern states.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Murmurs:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Aortic insufficiency
Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that’s best heard when the patient sits and leans forward and at the end of a forced held expiration. S2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.
Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that’s best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur—a rumbling, mid-to-late diastolic murmur best heard at the apex—may also occur. Complications may not develop until ages 40 to 50; then, typical findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.
Aortic stenosis
With this valvular disorder, the murmur is systolic, beginning after S1 and ending at or before aortic valve closure. It’s harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb’s point), and over the carotid arteries.
If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical but is absent when the valve is severely calcified. Associated signs and symptoms usually don’t appear until age 30 in congenital aortic stenosis, ages 30 to 65 in stenosis due to rheumatic disease, and after age 65 in calcific aortic stenosis. They may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.
Cardiomyopathy (hypertrophic)
This disorder generates a harsh late systolic murmur, ending at S2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S3or S4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.
Mitral insufficiency
Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S2 and commonly an S4. This murmur doesn’t get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.
Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that’s loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.
Mitral prolapse
This disorder generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.
Mitral stenosis
With this valvular disorder, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S1 or an opening snap—a cardinal sign. It’s best heard at the apex with the patient in the left lateral position. Mild exercise will help make this murmur audible.
With severe stenosis, the murmur of mitral insufficiency may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.
Myxomas
A left atrial myxoma (most common) usually produces a middiastolic murmur and a holosystolic murmur that’s loudest at the apex, with an S4, an early diastolic thudding sound (tumor plop), and a loud, widely split S1.Related features include dyspnea, orthopnea, chest pain, fatigue, weight loss, and syncope.
A right atrial myxoma causes a late diastolic rumbling murmur, a holosystolic crescendo murmur, and tumor plop, best heard at the lower left sternal border. Other findings include fatigue, peripheral edema, ascites, and hepatomegaly.
A left ventricular myxoma (rare) produces a systolic murmur, best heard at the lower left sternal border, arrhythmias, dyspnea, and syncope.
A right ventricular myxoma commonly generates a systolic ejection murmur with delayed S2 and a tumor plop, best heard at the left sternal border. It’s accompanied by peripheral edema, hepatomegaly, ascites, dyspnea, and syncope.
Papillary muscle rupture
With this life-threatening complication of an acute MI, a loud holosystolic murmur can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.
Rheumatic fever with pericarditis
A pericardial friction rub along with murmurs and gallops are heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard are the systolic murmur of mitral insufficiency, a midsystolic murmur due to swelling of the leaflet of the mitral valve, and the diastolic murmur of aortic insufficiency. Other signs and symptoms include fever, joint and sternal pain, edema, and tachypnea.
Tricuspid insufficiency
This valvular abnormality is characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo’s sign), decreases with exhalation and Valsalva’s maneuver, and is best heard over the lower left sternal border and the xiphoid area. Following a lengthy asymptomatic period, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.
Tricuspid stenosis
This valvular disorder produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva’s maneuver. S1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.
Other causes
Treatments
Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Pulse rhythm abnormality:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Arrhythmias
An abnormal pulse rhythm may be the only sign of a cardiac arrhythmia. The patient may complain of palpitations, a fluttering heartbeat, or weak and skipped beats. Pulses may be weak and rapid or slow. Depending on the specific arrhythmia, dull chest pain or discomfort and hypotension may occur. Associated findings, if any, reflect decreased cardiac output. Neurologic findings, for example, include confusion, dizziness, light-headedness, decreased LOC and, sometimes, seizures. Other findings include decreased urine output, dyspnea, tachypnea, pallor, and diaphoresis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Cardiomegaly/Congestive Heart Failure:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Congestive heart failure
❑ Hypertensive left ventricular hypertrophy
❑ Anterior myocardial ischemia
❑ Athlete’s heart
❑ Mitral regurgitation
❑ Aortic stenosis
❑ High output
❑ Hypertrophic obstructive cardiomyopathy
❑ Pulmonary hypertension
❑ Cor pulmonale
❑ Dilated cardiomyopathy
❑ Endocarditis
❑ Pericardial effusion
❑ Left ventricular aneurysm
❑ Mitral stenosis
❑ Amyloidosis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Discrete Heart Sounds:
Differential Overview
(Field Guide to Bedside Diagnosis)
Phenomena
❑ S4 gallop
❑ Midsystolic click
❑ S3 gallop
❑ Loud S2
❑ Widely split S1
❑ Widely split S2
❑ Ejection click
❑ Variable S1
❑ Paradoxical splitting of S2
❑ Loud S1
❑ Fixed splitting of S2
❑ Opening snap
❑ Pericardial knock
❑ Tumor plop
❑ Sail sound
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Diastolic Murmur:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Aortic regurgitation
❑ Pulmonic regurgitation
❑ Mitral stenosis
❑ Tricuspid stenosis
❑ Atrial septal defect
❑ Left anterior descending artery stenosis
❑ Atrial myxoma
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Systolic Murmur:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Systolic ejection murmur
❑ Mitral regurgitation
❑ Mitral valve prolapse
❑ Aortic stenosis
❑ Aortic valve sclerosis
❑ Hypertrophic obstructive cardiomyopathy
❑ Atrial septal defect
❑ Pulmonic stenosis
❑ Tricuspid regurgitation
❑ Ventricular septal defect
❑ Aortic coarctation
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Continuous Murmur:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Aortic stenosis/aortic insufficiency
❑ Pericardial friction rub
❑ Pulmonary arteriovenous fistula
❑ Venous hum
❑ Mammary souffle
❑ Aortic coarctation
❑ Mediastinal air dissection
❑ Patent ductus arteriosis
❑ Ruptured sinus of Valsalva
❑ Coronary artery fistula
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Cardiac arrhythmias:
Causes
(Handbook of Diseases)
Arrhythmias may be congenital, or they may result from one of several factors, including myocardial ischemia, a myocardial infarction, and organic heart disease. Drug toxicity or degeneration of the conductive tissue necessary to maintain normal heart rhythm (sick sinus syndrome) sometimes can also precipitate arrhythmias.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Cardiac tamponade:
Causes
(Handbook of Diseases)
Increased intrapericardial pressure and cardiac tamponade may be idiopathic (Dressler’s syndrome) or may result from any of the following conditions:
❑ effusion (in patients with cancer, a bacterial infection, tuberculosis or, rarely, acute rheumatic fever)
❑ hemorrhage from trauma (such as gunshot or stab wounds of the chest and perforation by a catheter during cardiac or central venous catheterization or after cardiac surgery)
❑ hemorrhage from nontraumatic causes (such as rupture of the heart or great vessels or anticoagulant therapy in a patient with pericarditis)
❑ acute myocardial infarction (MI)
❑ uremia.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Heart failure:
Causes
(Handbook of Diseases)
Heart failure may result from a primary abnormality of the heart muscle (such as an infarction), inadequate myocardial perfusion due to coronary artery disease, or cardiomyopathy. Other causes include:
❑ mechanical disturbances in ventricular filling during diastole when there’s too little blood for the ventricle to pump, as in mitral stenosis secondary to rheumatic heart disease or constrictive pericarditis and atrial fibrillation
❑ systolic hemodynamic disturbances such as excessive cardiac workload due to volume overloading or pressure overload that limit the heart’s pumping ability.
These disturbances can result from mitral or aortic insufficiency, which causes volume overloading, and aortic stenosis or systemic hypertension, which results in increased resistance to ventricular emptying.
Reduced cardiac output triggers three compensatory mechanisms: ventricular dilation, hypertrophy, and increased sympathetic activity. These mechanisms improve cardiac output at the expense of increased ventricular work.
Cardiac dilation
In cardiac dilation, an increase in end-diastolic ventricular volume (preload) causes increased stroke work and stroke volume during contraction, stretching cardiac muscle fibers beyond optimum limits and producing pulmonary congestion and pulmonary hypertension, which lead in turn to right-sided heart failure.
Ventricular hypertrophy
In ventricular hypertrophy, an increase in muscle mass or the diameter of the left ventricle allows the heart to pump against increased resistance (impedance) to the outflow of blood.
An increase in ventricular diastolic pressure necessary to fill the enlarged ventricle may compromise diastolic coronary blood flow, limiting the oxygen supply to the ventricle and causing ischemia and impaired myocardial contractility.
Increased sympathetic activity
As a response to decreased cardiac output and blood pressure, increased sympathetic activity occurs by enhancing peripheral vascular resistance, contractility, heart rate, and venous return.
Signs of increased sympathetic activity, such as cool extremities and clamminess, may indicate impending heart failure. Increased sympathetic activity also restricts blood flow to the kidneys, which respond by reducing the glomerular filtration rate and increasing tubular reabsorption of sodium and water, in turn expanding the circulating blood volume. This renal mechanism, if unchecked, can aggravate congestion and produce overt edema.
Chronic heart failure may worsen as a result of respiratory tract infections, pulmonary embolism, stress, increased sodium or water intake, and failure to comply with the prescribed treatment regimen.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Rheumatic fever and rheumatic heart disease:
Causes
(Handbook of Diseases)
Rheumatic fever appears to be a hypersensitivity reaction to a group A beta-hemolytic streptococcal infection, in which antibodies manufactured to combat streptococci react and produce characteristic lesions at specific tissue sites, especially in the heart and joints. About 3% of patients with untreated streptococcal infections develop rheumatic fever.
Although rheumatic fever tends to run in families, this may merely reflect contributing environmental factors. It primarily affects children between ages 6 and 15, usually within 1 to 5 weeks after strep throat or scarlet fever. The disease strikes most often during cool, damp weather in winter and early spring. In the United States, it’s most common in the northern states.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Murmurs:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Aortic insufficiency
Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that’s best heard when the patient sits and leans forward and at the end of a forced held expiration. S
2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.
Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that’s best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur — a rumbling, mid-to-late diastolic murmur best heard at the apex — may also occur. Complications may not develop until ages 40 to 50; then, typical findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.
Aortic stenosis
With aortic stenosis — avalvular disorder — the murmur is systolic, beginning after S
1 and ending at or before aortic valve closure. It’s harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb’s point), and over the carotid arteries.
If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical but is absent when the valve is severely calcified. Associated signs and symptoms usually don’t appear until age 30 in congenital aortic stenosis, ages 30 to 65 in stenosis due to rheumatic disease, and after age 65 in calcific aortic stenosis. They may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.
Cardiomyopathy (hypertrophic)
Cardiomyopathy generates a harsh late systolic murmur, ending at S
2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S
3or S
4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.
Mitral insufficiency
Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S
2 and commonly an S
4. This murmur doesn’t get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.
Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that’s loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.
Mitral prolapse
Mitral prolapse generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex and left sternal border. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.
Mitral stenosis
With mitral stenosis, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S
1 or an opening snap — a cardinal sign. It’s best heard at the apex with the patient in the left lateral position. Mild exercise will help make this murmur audible.
With severe stenosis, the murmur of mitral regurgitation may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.
Myxomas
A left atrial myxoma (most common) usually produces a middiastolic murmur and a holosystolic murmur that’s loudest at the apex, with an S
4, an early diastolic thudding sound (tumor plop), and a loud, widely split S
1.Related features include dyspnea, orthopnea, chest pain, fatigue, weight loss, and syncope.
A right atrial myxoma causes a late diastolic rumbling murmur, a holosystolic crescendo murmur, and tumor plop, best heard at the lower left sternal border. Other findings include fatigue, peripheral edema, ascites, and hepatomegaly.
A left ventricular myxoma (rare) produces a systolic murmur, best heard at the lower left sternal border, arrhythmias, dyspnea, and syncope.
A right ventricular myxoma commonly generates a systolic ejection murmur with delayed S2 and a tumor plop, best heard at the left sternal border. It’s accompanied by peripheral edema, hepatomegaly, ascites, dyspnea, and syncope.
Papillary muscle rupture
Papillary muscle rupture is a life-threatening complication of an acute MI, in which a loud holosystolic murmur can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.
Rheumatic fever with pericarditis
A pericardial friction rub along with murmurs and gallops are heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard are the systolic murmur of mitral regurgitation, a midsystolic murmur due to swelling of the leaflet of the mitral valve, and the diastolic murmur of aortic regurgitation. Other signs and symptoms include fever, joint and sternal pain, edema, and tachypnea.
Tricuspid insufficiency
Tricuspid insufficiency is a valvular abnormality that’s characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo’s sign), decreases with exhalation and Valsalva’s maneuver, and is best heard over the lower left sternal border and the xiphoid area. Following a lengthy asymptomatic period, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.
Tricuspid stenosis
Tricuspid stenosis is a valvular disorder that produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva’s maneuver. S
1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.
Other causes
Medical treatments
Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Pulse rhythm abnormality:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Arrhythmias
An abnormal pulse rhythm may be the only sign of a cardiac arrhythmia. The patient may complain of palpitations, a fluttering heartbeat, or weak and skipped beats. Pulses may be weak and rapid or slow. Depending on the specific arrhythmia, dull chest pain or discomfort and hypotension may occur. Associated findings, if any, reflect decreased cardiac output. Neurologic findings, for example, include confusion, dizziness, light-headedness, a decreased LOC and, sometimes, seizures. Other findings include decreased urine output, dyspnea, tachypnea, pallor, and diaphoresis.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Murmurs:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Aortic insufficiency
Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that’s best heard when the patient sits and leans forward and at the end of a forced held expiration. S2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.
Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that’s best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur — a rumbling, mid-to-late diastolic murmur best heard at the apex — may also occur. Findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.
Aortic stenosis
With aortic stenosis, the murmur is systolic, beginning after S1 and ending at or before aortic valve closure. It’s harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb’s point), and over the carotid arteries.
If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical but is absent when the valve is severely calcified. Associated signs and symptoms may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.
Cardiomyopathy (hypertrophic)
Hypertrophic cardiomyopathy generates a harsh late systolic murmur, ending at S2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S3or S4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.
Mitral insufficiency
Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S2 and commonly an S4. This murmur doesn’t get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.
Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that’s loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.
Mitral prolapse
Mitral prolapse generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.
Mitral stenosis
With mitral stenosis, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S1 or an opening snap — a cardinal sign. It’s best heard at the apex with the patient in the left lateral position. Mild exercise will help make this murmur audible.
With severe stenosis, the murmur of mitral insufficiency may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.
Papillary muscle rupture
Papillary muscle rupture, a life-threatening complication of an acute MI, produces a loud holosystolic murmur that can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.
Rheumatic fever with pericarditis
A pericardial friction rub along with murmurs and gallops is heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard in patients with rheumatic fever are the systolic murmur of mitral insufficiency, a midsystolic murmur due to swelling of the leaflet of the mitral valve, and the diastolic murmur of aortic insufficiency. Other signs and symptoms include fever, joint and sternal pain, edema, and tachypnea.
Tricuspid insufficiency
Tricuspid insufficiency is a valvular abnormality that’s characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo’s sign) and decreases with exhalation and Valsalva’s maneuver. This murmur is best heard over the lower left sternal border and the xiphoid area. Following a lengthy period without symptoms, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.
Tricuspid stenosis
Tricuspid stenosis is a valvular disorder that produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva’s maneuver. S1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.
Other causes
Treatments
Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Pulse rhythm abnormality:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Cardiac arrhythmias
An abnormal pulse rhythm may be the only sign of a cardiac arrhythmia. The patient may complain of palpitations, a fluttering heartbeat, or weak and skipped beats. Pulses may be weak and rapid or slow. Depending on the specific arrhythmia, dull chest pain or discomfort and hypotension may occur. Associated findings, if any, reflect decreased cardiac output. Neurologic findings, for example, include confusion, dizziness, light-headedness, decreased LOC and, sometimes, seizures. Other findings include decreased urine output, dyspnea, tachypnea, pallor, and diaphoresis.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Heart Murmurs (Asymptomatic):
Principal Causes of Heart Murmurs (Asymptomatic)
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Normalmurmurs
- Systolicejection murmurs
- Vibratory systolic murmur
- Pulmonary systolic murmur (pulmonarytrunk)
- Physiologic peripheral pulmonary systolicmurmur (pulmonary branches)
- Supraclavicular or brachiocephalicmurmur
- Continuous murmurs
- Venoushum
- Pathologic murmurs
- Systolicmurmurs
- Maximalintensity at the upper right sternal border
- Valvaraortic stenosis
- Maximal intensity at the upper leftsternal border
- Valvar pulmonic stenosis
- Atrial septal defects
- Mild-to-moderate coarctation of theaorta
- Small patent ductus arteriosus
- Maximal intensity at the lower leftsternal border
- Ventricular septal defect
- Tricuspid incompetence
- Maximal intensity at the apex
- Mitralincompetence
- Mitral valve prolapse
- Diastolic murmurs
- Maximalintensity at the upper right sternal border
- Aorticvalve incompetence
- Maximal intensity at the upper leftsternal border
- Pulmonic valve incompetence
- Maximal intensity at the lower leftsternal border
- Atrial septal defects
- Tricuspid stenosis
- Moderate-to-severe tricuspid incompetence
- Maximal intensity at the apex
- Mitralstenosis
- Moderate-to-severe mitral incompetence
- Moderate left-to-right shunt lesions
- Continuous murmurs
- Maximalintensity at the upper left sternal border
- Moderate patent ductus arteriosus
- Maximal intensity at the left mid sternalborder
- Aorticpulmonary window
- Maximal intensity with variable location
- Coronaryarteriovenous fistula
- Systemic arteriovenous fistula
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Cardiac Failure:
Principal Causes of Cardiac Failure
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Excessivevolume load
- Left-to-rightshunt lesions
- Patentductus arteriosus
- Ventricular septal defect
- Atrial septal defect (ostium secundum)
- Atrioventricular canal defects
- Ostiumprimum defect
- Complete atrioventricular canal
- Aortic pulmonary window
- Total anomalous pulmonary venous connectionwithout obstruction
- Systemic arteriovenous fistulas
- Valvular incompetence
- Aorticincompetence
- Mitral incompetence
- Pulmonary incompetence
- Tricuspid incompetence
- Excessive pressure load
- Left ventricularoutflow tract obstruction
- Hypertrophic cardiomyopathy
- Congenital valvar aortic stenosis
- Discrete subvalvar aortic stenosis
- Supravalvar aortic stenosis
- Aortic arch hypoplasia or interruption
- Localized juxtaductal coarctation ofthe aorta
- Right ventricular outflow tract obstruction
- Congenitalvalvar pulmonic stenosis
- Left ventricular inflow tract obstruction
- Pulmonaryvein stenosis
- Total anomalous pulmonary venous connectionwith obstruction
- Cor triatriatum
- Supravalvular stenosing ring of theleft atrium
- Tumor
- Mitral valve obstruction (atresia,stenosis, parachute mitral valve)
- Right ventricular inflow tract obstruction
- Systemicvenous obstruction
- Right atrium obstruction
- Tricuspid valve obstruction
- Ebstein anomaly
- Cor pulmonale
- Systemic hypertension
- Disturbance in myocardial function
- Acuterheumatic fever and rheumatic heart disease
- Kawasaki disease
- Myocarditis
- Pericarditis
- Endocarditis
- Cardiomyopathy
- Myocardial infarction
- Anomalousleft coronary artery from the pulmonary artery
- Atherosclerosis
- Cardiac tumor
- Metabolic heart disease
- Perinatalasphyxia
- Hypocalcemia
- Hypoglycemia
- Severe anemia
- Drugs
- Complex anatomic lesions
- Hypoplasticleft heart complex
- Transposition of the great arterieswith a large ventricular septal defect
- Double-outlet right ventricle
- Truncus arteriosus
- Univentricular atrioventricular connections
- Abnormal cardiac rhythms
- Supraventriculartachycardia
- Atrial flutter
- Complete heart block
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Murmurs:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Aortic insufficiency.Acute aortic insufficiency typically produces a soft, short diastolic murmur over the left sternal border that's best heard when the patient sits and leans forward and at the end of a forced held expiration. S2 may be soft or absent. Sometimes, a soft, short midsystolic murmur may also be heard over the second right intercostal space. Associated findings include tachycardia, dyspnea, jugular vein distention, crackles, increased fatigue, and pale, cool extremities.
Chronic aortic insufficiency causes a high-pitched, blowing, decrescendo diastolic murmur that's best heard over the second or third right intercostal space or the left sternal border with the patient sitting, leaning forward, and holding his breath after deep expiration. An Austin Flint murmur—a rumbling, mid-to-late diastolic murmur best heard at the apex—may also occur. Complications may not develop until the patient is between ages 40 and 50; then, typical findings include palpitations, tachycardia, angina, increased fatigue, dyspnea, orthopnea, and crackles.
Aortic stenosis.With aortic stenosis, the murmur is systolic, beginning after S1 and ending at or before aortic valve closure. It's harsh and grating, medium-pitched, and crescendo-decrescendo. Loudest over the second right intercostal space when the patient is sitting and leaning forward, this murmur may also be heard at the apex, at the suprasternal notch (Erb's point), and over the carotid arteries.
If the patient has advanced disease, S2 may be heard as a single sound, with inaudible aortic closure. An early systolic ejection click at the apex is typical, but is absent when the valve is severely calcified. Associated signs and symptoms usually don't appear until age 30 in congenital aortic stenosis, ages 30 to 65 in stenosis due to rheumatic disease, and after age 65 in calcific aortic stenosis. They may include dizziness, syncope, dyspnea on exertion, paroxysmal nocturnal dyspnea, fatigue, and angina.
Cardiomyopathy (hypertrophic).Hypertrophic cardiomyopathygenerates a harsh late-systolic murmur, ending at S2. Best heard over the left sternal border and at the apex, the murmur is commonly accompanied by an audible S3 or S4. The murmur decreases with squatting and increases with sitting down. Major associated symptoms are dyspnea and chest pain; palpitations, dizziness, and syncope may also occur.
Mitral insufficiency.Acute mitral insufficiency is characterized by a medium-pitched blowing, early systolic or holosystolic decrescendo murmur at the apex, along with a widely split S2 and commonly an S4. This murmur doesn't get louder on inspiration as with tricuspid insufficiency. Associated findings typically include tachycardia and signs of acute pulmonary edema.
Chronic mitral insufficiency produces a high-pitched, blowing, holosystolic plateau murmur that's loudest at the apex and usually radiates to the axilla or back. Fatigue, dyspnea, and palpitations may also occur.
Mitral prolapse.Mitral prolapse generates a midsystolic to late-systolic click with a high-pitched late-systolic crescendo murmur, best heard at the apex. Occasionally, multiple clicks may be heard, with or without a systolic murmur. Associated findings include cardiac awareness, migraine headaches, dizziness, weakness, syncope, palpitations, chest pain, dyspnea, severe episodic fatigue, mood swings, and anxiety.
Mitral stenosis.With mitral stenosis, the murmur is soft, low-pitched, rumbling, crescendo-decrescendo, and diastolic, accompanied by a loud S1 or an opening snap—a cardinal sign. It's best heard at the apex with the patient in the left lateral position. Mild exercise helps make this murmur audible.
With severe stenosis, the murmur of mitral insufficiency may also be heard. Other findings include hemoptysis, exertional dyspnea and fatigue, and signs of acute pulmonary edema.
Myxomas.A left atrial myxoma (most common) usually produces a mid-diastolic murmur and a holosystolic murmur that's loudest at the apex, with an S4, an early diastolic thudding sound (tumor plop), and a loud, widely split S1.Related features include dyspnea, orthopnea, chest pain, fatigue, weight loss, and syncope.
A right atrial myxoma causes a late-diastolic rumbling murmur, a holosystolic crescendo murmur, and tumor plop, best heard at the lower left sternal border. Other findings include fatigue, peripheral edema, ascites, and hepatomegaly.
A left ventricular myxoma (rare) produces a systolic murmur, best heard at the lower left sternal border; arrhythmias; dyspnea; and syncope.
A right ventricular myxoma commonly generates a systolic ejection murmur with delayed S2 and a tumor plop, best heard at the left sternal border. It's accompanied by peripheral edema, hepatomegaly, ascites, dyspnea, and syncope.
Papillary muscle rupture.With papillary muscle rupture—a life-threatening complication of an acute MI—a loud holosystolic murmur can be auscultated at the apex. Related findings include severe dyspnea, chest pain, syncope, hemoptysis, tachycardia, and hypotension.
Rheumatic fever with pericarditis.With rheumatic fever, a pericardial friction rub along with murmurs and gallops are heard best with the patient leaning forward on his hands and knees during forced expiration. The most common murmurs heard are the systolic murmur of mitral insufficiency, a midsystolic murmur due to swelling of the mitral valve leaflet, and the diastolic murmur of aortic insufficiency. Other signs and symptoms include fever, joint and sternal pain, edema, and tachypnea.
Tricuspid insufficiency.Tricuspid insufficiency is characterized by a soft, high-pitched, holosystolic blowing murmur that increases with inspiration (Carvallo's sign), decreases with exhalation and Valsalva's maneuver, and is best heard over the lower left sternal border and the xiphoid area. Following a lengthy period without symptoms, exertional dyspnea and orthopnea may develop, along with jugular vein distention, ascites, peripheral cyanosis and edema, muscle wasting, fatigue, weakness, and syncope.
Tricuspid stenosis.Tricuspid stenosis produces a diastolic murmur similar to that of mitral stenosis, but louder with inspiration and decreased with exhalation and Valsalva's maneuver. S1 may also be louder. Associated signs and symptoms include fatigue, syncope, peripheral edema, jugular vein distention, ascites, hepatomegaly, and dyspnea.
Other causes
Treatments.Prosthetic valve replacement may cause variable murmurs, depending on the location, valve composition, and method of operation.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Pulse rhythm abnormality:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Arrhythmias.An abnormal pulse rhythm may be the only sign of a cardiac arrhythmia. The patient may complain of palpitations, a fluttering heartbeat, or weak and skipped beats. Pulses may be weak and rapid or slow. Depending on the specific arrhythmia, dull chest pain or discomfort and hypotension may occur. Associated findings, if any, reflect decreased cardiac output. Neurologic findings, for example, include confusion, dizziness, light-headedness, decreased LOC and, sometimes, seizures. Other findings include decreased urine output, dyspnea, tachypnea, pallor, and diaphoresis.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Learning Problems:
Learning Problems - etiology
(The 5-Minute Pediatric Consult)
Speculative etiologies (widely discussed but essentially unproven):
- Food allergies
- “Developmental optometric” disorders
- Exposure to food preservatives or sugar
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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