EKG and Heart Murmur Review - Part 2

Summary

This educational video presents 10 case studies, each focusing on a patient with distinct cardiovascular symptoms and corresponding EKG findings. From mitral regurgitation to hypertrophic obstructive cardiomyopathy and pulmonary hypertension, the video illustrates how to correlate auscultation sounds (e.g., murmurs, extra heart sounds) with diagnostic EKG features. With detailed explanations of heart block, LVH, and right bundle branch block, the content provides valuable insights for clinicians in diagnosing complex cardiac conditions. The cases aim to enhance understanding of how heart murmurs and EKGs contribute to accurate diagnosis, especially in challenging scenarios.

Takeaways

• 😀 The video focuses on interpreting EKGs and understanding cardiac oscillations through case studies, with each case involving a brief patient history, cardiac sounds, and an EKG.
• 😀 Case 6 presents a 46-year-old woman with mitral regurgitation and probable heart failure, evidenced by a holosystolic murmur and left atrial enlargement on the EKG.
• 😀 Case 7 describes a 32-year-old woman with pulmonary hypertension, with EKG findings showing right axis deviation, right atrial enlargement, and right ventricular hypertrophy.
• 😀 Case 8 features a 22-year-old man with hypertrophic obstructive cardiomyopathy, with a harsh crescendo-decrescendo systolic murmur and profound LVH on EKG.
• 😀 Case 9 discusses a 45-year-old man with complete heart block caused by beta-blocker toxicity, demonstrated by variable S1 intensity and a ventricular rate around 36 beats per minute.
• 😀 Case 10 involves a 56-year-old man with a massive pulmonary embolism, where a widely split S2, right-sided S3, and right bundle branch block are key EKG indicators.
• 😀 Pulmonary hypertension in case 7 can be caused by various factors, including primary pulmonary hypertension, chronic thromboembolic disease, or rheumatologic conditions.
• 😀 Hypertrophic obstructive cardiomyopathy in case 8 is best distinguished from aortic stenosis by the increase in murmur intensity with maneuvers that decrease LV preload.
• 😀 Case 9 emphasizes the association between heart block and the variable intensity of S1, with sinus P waves and complete dissociation from the QRS complexes.
• 😀 Case 10 highlights the importance of recognizing right-sided heart failure and the connection between S3 and right bundle branch block as signs of massive pulmonary embolism.

Q & A

What is the main clinical feature in Case 6, and how does it relate to the EKG findings?

In Case 6, the patient exhibits a holosystolic murmur with an additional low-pitched sound, an S3, which suggests heart failure. The EKG shows normal sinus rhythm, left atrial enlargement, and mild left ventricular hypertrophy (LVH), indicating mitral regurgitation with probable heart failure.

How does respiratory variation impact the auscultation in Case 7?

In Case 7, respiratory variation is notable as the second component of S2 (P2) becomes louder during inspiration. This is indicative of systemic hypertension, with aortic valve closure being more pronounced. The variation also suggests the presence of pulmonary hypertension.

What are the key features of the EKG in Case 7 that suggest pulmonary hypertension?

In Case 7, the EKG shows sinus rhythm with right axis deviation, right ventricular hypertrophy (RVH), and possible right atrial enlargement, which, in conjunction with the clinical history, suggest pulmonary hypertension.

Why is the crescendo-decrescendo systolic murmur in Case 8 suggestive of hypertrophic obstructive cardiomyopathy?

The crescendo-decrescendo systolic murmur in Case 8, especially when intensified by maneuvers like the Valsalva, points to hypertrophic obstructive cardiomyopathy. This condition results in a thickened left ventricle obstructing blood flow, producing a characteristic murmur.

What does the EKG in Case 8 reveal about the patient's condition?

The EKG in Case 8 shows signs of profound left ventricular hypertrophy (LVH), with large QRS complexes, ST depressions, T-wave inversions, and concave ST elevations. These findings, along with the murmur, suggest hypertrophic obstructive cardiomyopathy.

How does beta-blocker toxicity lead to complete heart block in Case 9?

In Case 9, the patient's complete heart block is most likely due to beta-blocker toxicity (atenolol). Beta-blockers can impair electrical conduction, and the renal failure seen in the patient exacerbates this effect, leading to a complete dissociation between atrial and ventricular activity.

What does the varying intensity of S1 indicate in Case 9?

The varying intensity of S1 in Case 9 is a direct consequence of complete heart block. The intensity of S1 depends on the timing of mitral valve closure, which is influenced by the relationship between atrial contraction and ventricular depolarization in heart block.

What is the significance of the widely split S2 and right-sided S3 in Case 10?

In Case 10, the widely split S2 and right-sided S3 suggest acute right-sided heart failure, likely due to a massive pulmonary embolism. The split S2 becomes more pronounced with inspiration, and the S3 is more prominent at the lower sternal border, indicating right ventricular overload.

What does the EKG in Case 10 reveal about the patient's cardiac condition?

The EKG in Case 10 shows normal sinus rhythm, but with prolonged QRS duration, indicating a right bundle branch block (RBBB). This, combined with the clinical signs, points to a massive pulmonary embolism causing right-sided heart failure.

How can one differentiate between hypertrophic cardiomyopathy and aortic stenosis based on the murmur changes?

In hypertrophic cardiomyopathy, the murmur increases in intensity with maneuvers that reduce left ventricular preload, such as the Valsalva maneuver or standing. In contrast, the murmur of aortic stenosis does not change or decreases with these maneuvers, which helps differentiate the two conditions.