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Hemodynamics and Physical Examination In Congenital Heart Disease Azaria JJT Rein, MD

Hemodynamics and Physical Examination In Congenital Heart Disease Azaria JJT Rein, MD. A Gene, Fetus, Baby, Child and Adult Saga. History of Cardiac Imaging. 3-D ECHOCARDIOGRAPHY 1997 TISSUE VELOCITY IMAGING. New Approaches in Diagnosis. 3 D Imaging. 4 CHAMBERS. Coarctation of the

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Hemodynamics and Physical Examination In Congenital Heart Disease Azaria JJT Rein, MD

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  1. Hemodynamics and Physical Examination In Congenital Heart Disease Azaria JJT Rein, MD

  2. A Gene, Fetus, Baby, Child and Adult Saga

  3. History of Cardiac Imaging • 3-D ECHOCARDIOGRAPHY • 1997 TISSUE VELOCITY IMAGING

  4. New Approaches in Diagnosis

  5. 3 D Imaging

  6. 4 CHAMBERS

  7. Coarctation of the Aorta

  8. Prenatal Cardiology

  9. a a THE FETAL KINETOCARDIOGRAM FKCG ~ ECG

  10. Interventional Pediatric Cardiology

  11. Atrial Septal Defect (ASD)

  12. Fetal Interventions

  13. Direct Puncture of LV in a Fetus

  14. "That it will ever come into general use, not withstanding its value, I am extremely doubtful; because its whole hue and character is foreign, and opposed to all our habits and associations.” "מבלי להמעיט בערכה של צורת בדיקה זו, אני בספק רב אם אי פעם השימוש בה יהפוך לנחלת הכלל, מפני שכל אופייה ומהותה זרים ומנוגדים להרגלינו ולדרך החשיבה שלנו." John Forbes, 1821

  15. CC 2003

  16. HEMODYNAMICS & PHYSICAL EXAMINATION - Medical History. - Inspection. - Palpation. - Percussion. - Auscultation.

  17. Medical History Antenatal - Family History. - Fetus. - Mother disease. Perinatal - Delivery. - APGAR score. - First sign & symptom. Postnatal...

  18. HEMODYNAMICS & PHYSICAL EXAMINATION - Medical History - Inspection - Palpation - Percussion - Auscultation

  19. Inspection Hi, I’m Alfred E. Neuman, you know, from Mad magazine?

  20. Inspection Why, me worry ???

  21. Inspection Why, me worry ???

  22. Inspection Yes, we both have Williams’ syndrome !

  23. Inspection Me too !!!

  24. Inspection With SVAS, SVPS, PPS and more !!!

  25. HEMODYNAMICS & PHYSICAL EXAMINATION AUSCULTATION - Heart Sounds. - Murmur. - Click/Snap

  26. Murmur and Hemodynamics

  27. . 2 P = 4 V P = 4 V Flow & Pressure THE SIMPLIFIED BERNOULLI EQUATION P in mm Hg . V in m/sec

  28. Murmur and Hemodynamics MURMUR LAMINAR FLOW -> TURBULENT FLOW INCREASED FLOW VELOCITY > 1.5 m/sec INCREASED PRESSURE GRADIENT > 10 mmHg

  29. Murmur Characteristics • Timing • Amplitude • Pitch • Location • Radiation • Response to maneuver

  30. Murmur Characteristics • Timing • Systole • Pansystolic • Ejection Type • Exceptions (Late SM, Short SM) • Diastole • Early • Mid • Continuous

  31. Systolic Murmur Ejection IVC systole S1 S2 SEM PSM

  32. Systolic Ejection Murmur Ejection IVC S1 S2 systole

  33. Pansystolic Murmur Ejection IVC systole S1 S2

  34. Diastole mo Filling IVR diastole S1 S2

  35. S1 S2 Early Diastolic Murmur Filling IVR

  36. S1 S2 Mid-Diastolic Murmur Filling IVR

  37. Continuous ( machinery) Murmur Aorta PA

  38. The Evolving PDA Murmur 1 day few days > 1-2 weeks

  39. The Amplitude of a Murmur Factors influencing the amplitude grading: - Acoustic energy - Media - Stethoscope - Ears & acoustic nerve - perception - subjective interpretation

  40. ΔP Pitch The Pitch of a Murmur

  41. Response to Maneuver Change in loading condition ( pre/ after load). Change in loading of right & left cardiac chambers. Change in timing of auscultatory event. Change in pressure gradient.

  42. CLICKS & SNAPS Wind Pressure Gradient = Sail Pliable valve HADASSAH Pediatric Cardiology H

  43. Systolic Ejection Click S2 S1

  44. Opening Snap S1 S2 OS

  45. Murmur Characteristics • Timing • Amplitude • Pitch • Location • Radiation • Response to maneuver

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