The heart systolic murmur

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1. The heart systolic murmur Done By : Dalal F. Alanazi Medical student at KFU

2. Objective The anatomy of the heart? What does parasternal mean? What is a murmur ? Types and digress of murmurs & same disease related to them? Normal & murmur heart sound ? Classification of cardiac murmurs? what causes of murmur? Diagnosis of murmur? The Final diagnosis for the case

3. Summary for the case .. During a routine sports examination, 14-year-old Elisabeth is found to have a fairly loud, systolic murmur in the 2th/3rd parasternal intercostal space. Physical examination shows no further abnormalities. Elisabeth experiences no restrictions during exercise. A chest X-ray shows the right atrium to be slightly enlarged and the pulmonary arteries dilated .

4. Parasternal intercostal space .. Parasternal : beside the sternum (adjacent to it). The parasternal window is located next to the sternum, between the  2rd and 5th intercostal spaces ..

5. Definition of Murmur .. Murmurs are pathologic and abnormal heart sounds during heartbeat cycle -such as whooshing or swishing- made by turbulent blood in or near the heart. These sounds can be heard with a stethoscope.

6. T ypes and digress of murmurs .. 1- Systolic murmur: a heart murmur that occurs during a heart muscle contraction which occur between S 1  and S 2 . 2- Diastolic murmur: a heart murmur that occurs during heart muscle relaxation between beats which occur between S 2  and S 1 .

7. Normal heart sounds .. Between the first and the second heart sounds there is systole . 2. Between the second and the next one there is diastole .

8. Cont .. Normal heart sounds Normally, there are two heart sounds: First heart sound means exposure to the A-V valve. Second heart sound means exposure to the semilunar valves.

9. Name of disease What is it ? Coronary artery disease or heart attack Blockages in your coronary arteries that limit blood flow to your heart muscle High blood pressure Elevated pressure in your arteries Aortic stenosis Opening of aortic valve is narrowed, impairing blood flow Arrhythmia Irregular heart rhythm Causes of systolic heart failure ..

10. Name of disease What is it? Coronary artery disease (CAD) Blockage of the arteries that supply blood to the heart. High blood pressure Elevated pressure in your arteries. Aortic stenosis Narrowed opening of the aortic valve. Pericardial disease Abnormality of the sac that surrounds the heart (pericardium ). Causes of Diastolic heart failure ..

11. Cardiac cycle

12. Cont.. Heart sounds

13. C lassification of cardiac murmurs .. murmurs helps to identify functional from pathological murmurs and to distinguish between the different types of pathological murmur..

14. Cont ..

15. Causes of murmur in heart .. Most heart murmurs are innocent : They are caused by blood flowing through healthy valves in a healthy heart and do not require treatment. However, heart murmurs can be caused by blood flowing through a damaged or overworked heart valve.

16. Cont.. Cause Fever Pregnancy anemia Physical activity or exercise An excessive amount of thyroid hormone in body hyperthyroidism

17. may result from a heart problem.. Heart valve abnormalities Holes in the heart ASD or cardiac shunts Rheumatic fever. Endocarditis Mitral valve prolapse 2. Causes of abnormal heart murmurs ..

18. How can we diagnose this case ?

19. Chest X-ray:   An X-ray image helps your doctor see the condition of your heart and lungs. Echocardiogram: This is a commonly used test.In echocardiography, sound waves produce a video image of the heart. It allows your doctor to see your heart's chambers and measure their pumping strength.. This test also checks heart valves and looks for any signs of heart defects*

20. Electrocardiogram (ECG). This test records the electrical activity of your heart and helps identify heart rhythm problems .. Cardiac catheterization. In this test, a thin, flexible tube (catheter) is inserted into a blood vessel at the groin or arm and guided to your heart. Through catheterization, doctors can diagnose congenital heart defects , test how well your heart is pumping and check the function of your heart valves .

21. Magnetic resonance imaging (MRI): is a technique that uses a magnetic field and radio waves to create 3-D images of all organs and tissues within your body. Pulse oximetry : This painless test measures how well oxygen is reaching your tissues. It helps detect whether oxygenated blood is mixing with deoxygenated blood*

22. Final diagnosis is Arterial septal defect Normally, the  right and left atria  are separated by a septum called the  interatrial septum . If this septum is defective or absent, then  oxygen-rich blood can flow directly from the left side of the heart to mix with the oxygen-poor blood in the right side of the heart. The right ventricle will be forced to generate higher pressures to try to overcome the pulmonary hypertension. This may lead to right ventricular failure .. (dilatation and decreased systolic function of the right ventricle)*

23. The deoxygenated (blue) blood will by pass the lungs and circulate throughout the systemic circulation resulting in blue coloration of the skin (right photo). Blue Baby Syndrome “ Cyanotic heart problems ” ..

24. Cont .. The symptoms based on the diameter of the opening (small or large) and, there is more than one opening.. Chest pain. Shortness of breath. vomiting. Rapid or irregular heartbeats. Swelling of legs, feet or abdomen. Stroke. Bluish skin color.

25. Summary Anatomy of the heart? What’s the parasternal & murmur means? What the murmur? Types with same diseases related to them.. Digress.. Classification.. Causes.. Diagnosis.. The Final diagnosis for the case?

26. Reference .. http://www.nlm.nih.gov/medlineplus/ency/article/000157.htm https://www.google.com.sa/url?sa=t&source=web&rct=j&ei=qP8MU8HOIfOZ0AXAj4FQ&url=http://www.nytimes.com/health/guides/disease/cyanotic-heart-disease/overview.html&cd=1&ved=0CCYQFjAA&usg=AFQjCNGZ5GnYFBp6c_Hgo846dkAALSzaAg http://www.blaufuss.org/arrow/Systole.html http://www.medicinenet.com/heart_disease_pictures_slideshow_visual_guide/article.htm http://www.webmd.com/heart-disease/heart-failure/tc/systolic-heart-failure-topic-overview http://www.webmd.com/heart-disease/heart-failure/tc/diastolic-heart-failure-topic-overview

27. Any Questions