PAGE INTERPRETATION | Tutorial D-1 CVS

130110110177|Gabriella Chafrina| 09/10/13

Dsypnea on Exertion (DON)
- Definition: difficulty breathing while performing a physical activity.
- Etiology: Insufficient tissue oxygenation by the blood
- The most common causes of DON is Heart Failure (HF), which result in both impaired perfusion ( CO) and
some types of failure, elevations in ulmonary capillary pressure leading to pulmonary edema
- Also called Shortness of Breath on Exertion (SOBOE) or Breathlessness on Exertion or Exertional Dsypnea

Mitral Faces
- Mitral faces refers to a distinctive facial appearance associated with mitral stenosis
- Etiology: CO perfusion of facial skin
- Clinical appearance: rosy cheeks, while the rest of the face has a bluish tinge

Jugular Venous Pressure (JVP)
- Distance that measure show distance between sternal angle surface with RA
- Normal: (5-2) to (5+2) H
2
O
- Also called Jugular Venous Pulse
- In our case: JVP (5+4) H
2
O increasing shows congestion of systemic veins

Point of Maximal Impulse (PMI)
- Definition: the point of the chest where pulsation of the left ventricle is sometimes felt or seen most strongly
- Also called apex beat
- Normally felt in 5
th
intercostal space, crossed with midclavicular line
- In our case: PMI was in midclavicular line and 5
th
intercostal space normal, indicating NO enlargement of LV

Thrill
- Definition: a vibration felt by the examiner on palpation that accompany cardiac or vascular murmur
- Caused by turbulance blood flow that pass incompetent valve or blood flow that passed small blood vessel to
bigger blood vessel
- In our case: NO thrill was palpable

S1 accentuated
- S1 heard in beginning of ventricular systole. S
1
caused by closing of AV valve, especially mitral valve (because
pressure in LV > pressure in RV)
- Etiology: forceful closure of mitral valve
- Pathophysiology: high pressure gradient between the atrium and ventricle mobile portions of mitral valve
leaflets widely separated throughout diastole at onset of systole, ventricular contraction abruptly slams the
leaflet together from the relatively wide position closure sound loudconnectio
- One of abnormality that cause S
1
accentuated is mitral stenosis
- In our case, S
1
accentuated showing possibly there is mitral stenosis

S
2
normally split with a loud pulmonic component
- S
2
caused by closing of aortic valve (A
2
) and pulmonary valve (P
2
). S
2
vary with respiratory cycle: heard as 1
during expiration, heard as 2 during inspiration (physiologic/normal splitting).
- P
2
is more smooth (less heard) than A
2

- In our case: there is normal split normal, and loud pulmonic component shows pulmonary hypertension




PAGE INTERPRETATION | Tutorial D-1 CVS

130110110177|Gabriella Chafrina| 09/10/13
Opening Snap (OS)
- Opening snap is high frequency sound result from sudden tensing of
chordae tendinae and stenotic leaflet on the opening of valve (mitral
stenotic) which heard during diastolic phase of auscultation
- In our case: opening snap was heard at the apex

Diastolic Murmur
- In our case: Diatolic murmur (II/IV) heard at upper right sternal border
means possibly there is aortic regurgitation and the intensity is faint but
immediately audible
- A mid-to-late diastolic murmur result from turbulent flow across a
stenotic mitral or tricuspid valve or less commonly from abnormally
flow across a normal mitral or tricuspid valve
- In our case: mid-diastolic rumbling murmur (III/IV) heard best at the apex
means possibly there is mitral stenosis and the intenstity is easily
heard

Systolic Murmur
- In our case: Systolic murmur (III/VI) heard best at left lower sternal
border means possibly there is tricuspid regurgitation and the
intensity is easily heard
- A systolic ejection murmur is typical of aortic or pulmonic valve stenosis.
It begins after S
1
and terminates before S
2

- In our case: Ejection systolic murmur (II/VI) heard at upper right sternal
border means possibly there is aortic stenosis and the intensity is faint
but immediately audible

Liver
- In our case: liver could be felt 3 cm below the costal margin means possibly there is hepatomegaly

Extremities
- In our case: pedal edema bilaterally means there is edema in foot, possibly caused by fluid transudate to
extrimities

BMI
Chart
(Women)