Heart murmurs for beginners Part 2: Atrial septal defect, ventricular septal defect & PDA🔥🔥🔥🔥
Summary
TLDREste video educativo aborda tres murmullos cardíacos: el murmullo sistólico de eycción con S2 dividido en la deficiencia del septo auricular, el murmullo pansistólico en la deficiencia del septo ventricular y el murmullo de máquina en el ducto arterioso patente. Explicado con detalle, se utiliza un enfoque visual y se brindan recordatorios sonoros para facilitar el aprendizaje y la memorización. Además, se discuten las implicaciones clínicas y el diagnóstico de cada condición, fomentando una comprensión profunda del tema.
Takeaways
- 🩺 Los murmullos cardíacos son producidos por el flujo sanguíneo turbulento y se pueden representar visualmente con patrones de onda de sonido.
- 🌊 El murmullo de la septum defectuosa auricular (ASD) se presenta con un murmullo sistólico de eyectar y una S2 dividida.
- 🧍 La comunicación anormal entre el atrio izquierdo y el derecho en la ASD se debe a la presencia de un defecto en el septum interauricular.
- 🚫 La presión arterial en el lado izquierdo del corazón es naturalmente más alta que en el derecho, lo que produce un gradiente de presión y un shunt de izquierda a derecha.
- 🌀 El aumento del volumen sanguíneo en el ventrículo derecho al pasar por la válvula pulmonar produce un flujo sanguíneo turbulento, lo que resulta en el murmullo sistólico.
- 🧵 Los defectos septales auriculares son más comunes en mujeres y pueden estar relacionados con el consumo de alcohol maternos durante el embarazo.
- 📉 Los defectos septales ventriculares (VSD) presentan un murmullo pansistólico, que ocurre a lo largo de toda la duración del sistole.
- 🛡 Un defecto en el septum interventricular permite una comunicación anormal entre el ventrículo izquierdo y el derecho, lo que causa un shunt de izquierda a derecha.
- 👶 Los defectos septales ventriculares son una forma común de enfermedad cardíaca congénita y pueden estar relacionados con factores genéticos y condiciones como el síndrome de Down.
- 🕰 El ductus arteriosus persistente (PDA) es una estructura vascular fetal que permite que la sangre bypassee los pulmones; si permanece abierto después del nacimiento, produce un shunt entre la aorta y la arteria pulmonar.
- 🔊 El murmullo de PDA es conocido como un murmullo de maquinaria y ocurre a lo largo del ciclo cardíaco, debido al flujo sanguíneo turbulento continuo.
- ⚕️ El PDA puede presentarse con síntomas como dificultad para respirar, infecciones respiratorias recurrentes o problemas para crecer.
Q & A
¿Qué murmullo se presenta con una septo interauricular defectuosa?
-El murmullo ejección sistólico con una S2 dividida.
Cómo se describe el murmullo en la deficiencia del septo interauricular?
-Es un murmullo que ocurre durante la sistole y es un murmullo que aumenta y disminuye (crescendo-decrescendo).
¿Dónde se localiza el murmullo de la deficiencia del septo interauricular?
-Es escuchado con mayor intensidad en el borde superior de la esternión izquierda y se propaga hacia la parte posterior del torax.
¿Qué es el murmullo pansistólico y cómo se relaciona con la deficiencia del septo interventricular?
-El murmullo pansistólico ocurre a lo largo de toda la duración de la sistole y se representa visualmente con una onda plana. Esto está relacionado con la deficiencia del septo interventricular, que permite una comunicación anormal entre los ventrículos izquierdo y derecho.
¿Qué causa el murmullo pansistólico en la deficiencia del septo interventricular?
-El murmullo pansistólico es causado por un flujo sanguíneo turbulento debido a un derrame izquierdo a derecho a través de la deficiencia del septo interventricular.
¿Cómo se describe el murmullo de la arteria ductus arteriosus persistente?
-El murmullo es descrito como un murmullo mecánico, similar a un sonido continuo y ronroneante que ocurre durante la sistole y diastole.
¿Qué estructura fetal es la arteria ductus arteriosus y qué sucede si no se cierra después del nacimiento?
-La arteria ductus arteriosus es una estructura vascular fetal que permite a la sangre evitar los pulmones durante el desarrollo fetal. Si no se cierra después del nacimiento, permite una comunicación anormal entre la aorta y la arteria pulmonar.
¿Qué factores aumentan el riesgo de desarrollar un arteria ductus arteriosus persistente?
-Los factores de riesgo incluyen el parto prematuro, la infección por rubéola durante el embarazo y el género femenino.
¿Qué síntomas pueden presentarse en un paciente con una deficiencia del septo interauricular?
-Pueden ser asintomáticos, pero también pueden tener dificultad para respirar y crecimiento deficiente. En la vida adulta, pueden desarrollar síntomas adicionales como un síndrome de Eisenmenger o accidentes cerebrovasculares isquémicos.
¿Qué es el síndrome de Eisenmenger y cómo se relaciona con la deficiencia del septo interauricular?
-El síndrome de Eisenmenger ocurre cuando el derrame izquierdo a derecho puede invertirse debido a un aumento en las presiones pulmonares, lo que lleva a una disminución en el flujo de sangre a la circulación arterial. Esto se relaciona con la deficiencia del septo interauricular ya que permite el derrame izquierdo a derecho.
¿Por qué es importante la identificación de las deficiencias cardíacas congenitas como la deficiencia del septo interauricular y el septo interventricular?
-La identificación temprana de estas deficiencias es crucial para proporcionar un tratamiento adecuado y prevenir complicaciones a largo plazo, como la insuficiencia cardíaca, la muerte súbita o accidentes cerebrovasculares.
Outlines
🧡 Revisión de los murmullos cardíacos: Defecto septal auricular
Este párrafo aborda la revisión de tres murmullos cardíacos, comenzando con el murmullo de la septal auricular. Se describe el murmullo como un ejection systolic murmur acompañado de una división del S2, que se presenta durante la sistole y es un murmullo que aumenta y disminuye (crescendo-decrescendo). Para facilitar la memorización, se utiliza la frase 'lub-wooshh-dubba'. Además, se explica la anatomía y la fisiopatología detrás del murmullo, incluyendo la comunicación anormal entre los atrios izquierdo y derecho debido a la defecto septal auricular. Se mencionan las posibles causas, como el uso materno de alcohol durante el embarazo, y los síntomas que pueden presentarse, como la disnea y el crecimiento deficiente. También se discute la posible reversión del shunt left-to-right y la síndrome de Eisenmenger que podría desarrollarse. Finalmente, se detalla la importancia de considerar un defecto septal auricular en cualquier joven que haya tenido un accidente cerebrovascular inexplicado.
🧡 Revisión de los murmullos cardíacos: Defecto septal ventricular y ducto arterioso patente
En este párrafo se abordan los otros dos murmullos cardíacos, el defecto septal ventricular y el ducto arterioso patente. El murmullo del defecto septal ventricular es un pansystolic murmur, que se representa visualmente con una onda plana y se produce debido a una comunicación anormal entre los ventrículos izquierdo y derecho. Se describe la dificultad para escuchar los sonidos S1 y S2 debido a la intensidad del murmullo. Por otro lado, el murmullo del ducto arterioso patente es un ruido mecánico que ocurre durante la sistole y diastole, y se debe a la persistencia de una estructura vascular fetal que permite la comunicación entre la aorta y la arteria pulmonar. Se mencionan factores de riesgo como el parto prematuro y la infección de rubéola materno. Los síntomas clínicos pueden incluir dificultad para respirar, infecciones respiratorias recurrentes o crecimiento deficiente. Finalmente, se invita a los espectadores a participar en la selección del tema de los siguientes videos y se agradece por su apoyo.
Mindmap
Keywords
Please replace the link and try again.
Highlights
Review of three heart murmurs including ejection systolic murmur, pan-systolic murmur, and machinery murmur.
Ejection systolic murmur with split S2 is associated with atrial septal defect.
Pan-systolic murmur is indicative of ventricular septal defect.
Machinery murmur is a characteristic of patent ductus arteriosus.
Turbulent blood flow due to cardiac defects produces audible vibrations, visualized as sound wave patterns.
Atrial septal defects allow abnormal communication between left and right atria.
Left-to-right shunt in atrial septal defect increases blood volume in right atrium and ventricle.
Ventricular septal defects are caused by abnormal development of the ventricular septum during fetal development.
Patent ductus arteriosus is a persistence of a fetal vascular structure after birth, creating a left-to-right shunt.
Atrial septal defects are more common in females and with maternal alcohol use during pregnancy.
Ventricular septal defects have increased risk with family history and conditions like Down syndrome.
Patent ductus arteriosus increases risk with premature birth and maternal rubella infection.
Atrial septal defect may present as ischemic stroke in later life due to blood clots passing from right to left side of the heart.
Clinical presentation of atrial septal defect may include dyspnea and faltering growth.
Ventricular septal defect murmur is loudest at the left sternal edge.
Patent ductus arteriosus murmur is a low-pitched, continuous sound loudest in the left infraclavicular area.
Self-test and YouTube community channel for topic voting and engagement.
Transcripts
[Music]
Hello and welcome back to the Learn Medicine show. My name is Dr. Coleman,
and in this episode, we will review three more heart murmurs. These murmurs include:
* The ejection systolic murmur with a split S2 found in atrial septal defect
* The pan-systolic murmur found in ventricular septal defect
* The machinery murmur found in the patent ductus arteriosus
By now, you should be familiar with our diagram that depicts one movement through the cardiac
cycle. You should also be familiar with the concept that turbulent blood flow produces audible
vibrations, which can be visually represented with these sound wave patterns. If none of this sounds
familiar, please go back and watch the previous video. I'll put a link at the top of the screen.
Okay, so let's start by reviewing the murmur of atrial septal defect. This presents with an
ejection systolic murmur and splitting of the S2 heart sound. This murmur occurs during systole and
is a crescendo-decrescendo murmur. To help commit this murmur to memory, you can use the phrase
"lub-wooshh-dubba." Okay, so let's add in the murmur now so you can appreciate how it sounds.
Okay, so let's take a moment to look at the atrial septal defect and how the murmur occurs.
Here is our diagram of the heart. Let's remove
the pulmonary artery and the aorta to get a closer look at what's going on.
So looking at this diagram, you'll see that the left atrium and the right atrium are separated by
a thin tissue called the interatrial septum. It's here where atrial septal defects occur.
Atrial septal defects effectively allow for an abnormal communication between
the left and the right atria. With this information in mind,
let's add in some blood flow and produce an animation to see what happens with this defect.
It's during diastole where we see most of the action with the atrial septal defect.
You can see here blood flowing from the atria into the ventricles.
But if we remove the aorta and the pulmonary artery,
we can get a closer look at what is happening. Blood pressure in the left side of the heart
is naturally higher than that in the right side of the heart. This produces a pressure gradient
that allows blood to flow from the left atrium into the right atrium.
This is known as a left-to-right shunt. The key point to take away here is that
the left-to-right shunt allows increased volume of blood to enter the right atrium
and subsequently the right ventricle. So let's continue now by adding back
in the aorta and the pulmonary artery. As usual, the S1 heart sound is produced
by closure of the mitral and tricuspid valves. This produces the sound "lub."
Systole then occurs and during this time, the ventricles contract and force blood through
the pulmonary and the aortic valves. It is the increased volume of blood in the right ventricle
being forced through the pulmonary valve that produces turbulent blood flow, resulting in our
crescendo-decrescendo systolic murmur. As systole comes to an end,
the aortic valve closes as normal, producing the first half of the S2 heart sound.
The second half of the S2 heart sound is produced by delayed closure of the pulmonary valve.
This delay occurs again because of the increased volume of blood
flowing out of the right ventricle. So let's watch this process now in an animation.
Atrial septal defects effectively allow for abnormal blood flow between the left and the
right atrium. They are usually congenital and caused by failed closure of the foramen ovale.
Atrial septal defects are more common in females
and also have increased frequency with maternal alcohol use during pregnancy.
In the clinical history, the presentation may be asymptomatic. However, those that
are symptomatic may have dyspnea and faltering growth. In later life, other symptoms may occur
by the age of 25. The left-to-right shunt can reverse due to increased pulmonary pressures
and this produces a syndrome called Eisenmenger's. Atrial septal defect may also present as ischemic
stroke in later life. Here, small blood clots form in the venous system and these
are able to pass from the right to the left side of the heart through the defect.
Once in the arterial circulation, they can go on to the brain to cause strokes. So any young
person that has an unexplained stroke should go on to have a check for atrial septal defect.
The murmur produced in atrial septal defect is an ejection systolic murmur
with splitting of the S2. It is heard loudest in the left upper sternal border
and radiates through to the back of the thorax.
And now let's turn our attention to ventricular septal defects. This presents as a pansystolic
murmur, which essentially means that it occurs throughout the entire duration of systole.
This murmur can be visually represented with a plateau wave. To commit this murmur to memory,
think about a bearing noise that occurs throughout the duration of systole. Let's listen to this now.
Let's take a moment to look at the anatomy of the ventricular septal defect. The left and
right ventricles are separated by a thin membrane of tissue known as the interventricular septum.
It is here where ventricular septal defects occur. This defect allows for
an abnormal communication between the left and the right ventricle.
Let's use an animation now to understand how the murmur occurs. Blood flows from the atria into
the ventricles, and as usual, the tricuspid and mitral valves close. However, due to increased
pressure in the left ventricle compared to the right ventricle, a left-to-right shunt
occurs across the ventricular septal defect. This produces turbulent blood flow, which generates
our pan-systolic murmur. The aortic and pulmonary valves close, and the cycle begins all over again.
It's worth noting that the S1 and S2 heart sounds are difficult to hear
in the context of a pan-systolic murmur, often because the murmur itself is so loud
that it drowns them out. Let's watch the animation now and listen to the murmur.
Let's pause for a moment to learn more about ventricular septal defects.
They effectively form an abnormal communication between the left and right ventricles. Ventricular
septal defects are a common type of congenital heart disease. It occurs due to abnormal
development of the ventricular septum early in fetal development. Genetics also contribute to
the development of ventricular septal defects. The risk is increased in those with a strong
family history and also in conditions such as trisomy 21, otherwise known as Down syndrome.
With ischemic heart disease, particularly with myocardial infarction, reduced blood supply to the
ventricular septum can cause it to break down and rupture, producing a ventricular septal defect.
The clinical history may be asymptomatic, but may include dyspnea and failure to thrive. The murmur
of ventricular septal defect is a pan-systolic murmur that is loudest at the left sternal edge.
Our final murmur in the series is that of patent ductus arteriosus. This is
described as a machinery murmur, and it occurs throughout systole and diastole.
The murmur is represented visually with a plateau wave that runs throughout systole and diastole.
To help commit this one to memory, think about a continuous burrrring sound that runs the whole
length of the cardiac cycle. We'll add in the murmur now so you can appreciate this:
The ductus arteriosus is a fetal vascular structure that allows blood to bypass the
lungs during fetal development. It usually closes 48 hours after birth, but if it remains patent,
then it allows an abnormal communication between the aorta and the pulmonary artery.
The murmur is produced due to the high aortic blood pressure and lower pulmonary pressures,
creating a gradient that allows for a left-to-right shunt,
where blood continuously flows from the aorta into the pulmonary artery. A continuous stream of
turbulent blood flow produces the machinery murmur both through systole and diastole.
While the murmur is being produced, the mitral and tricuspid valves close. The S1 heart sound
is not heard because the murmur is too loud and drowns it out. This is then followed by blood
being pumped into the pulmonary artery and the aorta. At the end of systole,
the pulmonary and the aortic valves close. The S2 heart sound is not heard again because
the murmur is too loud and drowns it out. The murmur continues to rumble throughout diastole.
So, the patent ductus arteriosus is the persistence of a fetal vascular structure
after birth. There is an increased risk of developing this condition with premature
birth, with maternal rubella infection during pregnancy, and with female gender. The history
may present with shortness of breath, recurrent respiratory infections, or failure to thrive.
Patent ductus arteriosus produces a machinery murmur, which is a low-pitched
rumbling burrowing sound that is continuous throughout systole and diastole. It is loudest
in the left infraclavicular area. Other signs you may see on clinical examination
are a systolic thrill, bounding peripheral pulse, and a widened pulse pressure.
And that brings us to the end of our heart murmurs module. Please take a look at the self-test that
I'm posting, where you can test your ability to identify murmurs by answering some simple
questions. Also, don't forget to head over to the YouTube community channel where you'll be able to
vote on the topic for the next Learn Medicine show. I really value your input because I want
to be making videos that are useful for you. And with that said, don't forget to like and
subscribe and share with your friends. Thanks for stopping by, and I'll see you in the next show!
Ver Más Videos Relacionados
Heart murmurs for beginners 🔥 🔥 🔥 Part 1:Aortic & Mitral stenosis, Aortic & mitral regurgitation.
Vitaminas: Liposolubles e Hidrosolubles– Fácil
GASTO CARDÍACO | ¡Fácil explicación! (Fisiología)
Como SUBIR La TESTOSTERONA De Forma Natural
Notación Científica División | Ejemplo 1
Función compuesta | Introducción
5.0 / 5 (0 votes)