Sopro Cardíaco: conheça os seus diferentes tipos

Summary

This script discusses cardiac murmurs, explaining their causes and types through analogies and medical knowledge. It covers the mechanisms behind murmurs, such as high blood flow velocity, obstruction, and sudden vessel dilation. The script differentiates between innocent and pathological murmurs and introduces the four classic types of murmurs: diamond, holosystolic, diastolic, and blowing. It also touches on the concept of thrill and how to palpate different cardiovascular sensations using various parts of the hand. The grading of cardiac murmurs is also explained, using the Levine scale from grade one to six.

Takeaways

• 💡 Systolic murmurs are sounds heard during the contraction phase of the heart, often indicating turbulent blood flow due to high velocity or obstruction.
• 🔍 Diastolic murmurs occur when blood flows back into the heart, typically associated with valvular regurgitation, and can be heard after the second heart sound.
• 🚑 The diamond-shaped murmur is characteristic of aortic stenosis, peaking in the middle of systole and is indicative of blood trying to pass through a narrowed aortic valve.
• 🩺 A 'blowing' murmur, like the flapping of a pigeon's wings, is often associated with mitral stenosis and is a more difficult sound to replicate but is very distinctive.
• 👂 The intensity of cardiac murmurs can be graded on a scale from one to six, with grade one being the softest and six being the loudest, potentially audible without a stethoscope.
• 👨‍⚕️ Auscultation techniques vary, and certain positions like sitting or lying on the left side can enhance the audibility of certain murmurs due to the heart's proximity to the chest wall.
• 🌊 Turbulent blood flow can be caused by high velocity, obstruction, or an abrupt increase in vessel caliber, leading to the production of murmurs.
• 🩸 The presence of a murmur does not necessarily indicate a disease; it can also be a sign of increased blood flow without any structural heart issues.
• 👂‍👃 The 'thrill' or fremitus is a palpable vibration that can be felt on the chest wall, often associated with significant murmurs and can help in diagnosing conditions like aortic stenosis.
• 📚 The script references Levine's classification for grading murmurs, which is a widely accepted method in clinical practice to standardize the description of heart sounds.

Q & A

What is the main reason for cardiac murmurs?

Cardiac murmurs are primarily caused by turbulent blood flow, which can be due to high velocity flow, obstruction, or an abrupt increase in vessel caliber.

How does the analogy of water flow in pipes relate to cardiac murmurs?

The analogy compares the sound of water flowing in pipes at different pressures and velocities to the sounds heard in cardiac murmurs. A quiet, laminar flow is compared to normal blood flow, while turbulent flow at high pressure is likened to the sounds heard in cardiac murmurs.

What are the three basic mechanisms that can cause blood flow to become turbulent and result in cardiac murmurs?

The three mechanisms are high-velocity flow, obstruction, and an abrupt increase in vessel caliber.

Why is a cardiac murmur not necessarily a sign of heart disease?

A cardiac murmur is a physical sign that may indicate something is altered in the heart, but it is not a disease in itself. It can also be caused by increased blood flow without any structural heart problem.

What is the difference between a cardiac murmur and a heart disease?

A cardiac murmur is a sound heard through a stethoscope that suggests turbulent blood flow, while heart disease refers to actual structural or functional abnormalities in the heart.

What is the significance of the diamond-shaped murmur in the script?

The diamond-shaped murmur is characteristic of aortic stenosis and is named for its graphical representation on a phonocardiogram, where it peaks in the middle of systole.

What does the term 'frémitus' refer to in the context of cardiac murmurs?

Frémitus refers to the palpable vibration or tremor felt when turbulent blood flow is passing through an area, indicating the presence of a cardiac murmur.

How are cardiac murmurs classified in terms of intensity?

Cardiac murmurs are classified on the Levine scale, ranging from grade one (barely audible) to grade six (audible with the stethoscope barely touching the chest or even without it).

What is the importance of the 'en rufler' murmur mentioned in the script?

The 'en rufler' murmur is characteristic of mitral stenosis and is likened to the sound of a dove's wings in flight. It is significant because it can indicate the presence of a specific type of heart condition.

What is the purpose of using different parts of the hand for palpation in cardiac examination as described in the script?

Different parts of the hand are used to palpate for various sensations in the cardiovascular system, such as the tip of the fingers for localized pulsations, the base of the fingers for fremitus, and the base of the hand for heave.

Why is the patient's position important when auscultating for cardiac murmurs?

The patient's position can affect the audibility of cardiac murmurs. For example, mitral murmurs are often better heard with the patient in the left lateral decubitus position, while aortic murmurs may be clearer with the patient sitting and leaning forward.