Cardiologia - gli algoritmi manovre

MANOVRE

Diagnosis Systolic murmur Second sound Effect of posture Amyl nitrate Phenylephrine Hypertrophic obstructive cardiomyopathy S1         S2 Variable i.e reversed partially reversed narrow or normal ↓         ↑ ↑ ↓ Mitral incompetence a. Pure severe Widely split ↓         ↑ ↑ ↓ b. Papillary muscle dysfunction EC Normal or partially reversed ↓         ↑ ↓ ↑ c. Mitral valve prolapse Normal ↓         ↑ ↓ ↑ d. Rheumatic of moderate degree Slightly wide ↓         ↑ ↓ ↑ Valvular aortic stenosis a. Mild to mod Narrow or partially reversed ↓         – ↓ ↑ b. Marked Reversed ↓         – ↓ ↑ Ventricular septal defect Slightly wide ↓         – ↓ ↑ Innocent vibratory systolic murmur Normal ↓         – ↓ –

EC=ejection click     – No change from control     ↑Degree of increase     ↓Degree of decrease

Diagrammatic representation of the character of the systolic murmur and of the second heart sound in several abnormalities. The effects of posture, amyl nitrite inhalation, and phenylephrine injection on the intensity of the murmur are shown. (With permission from Barlow, JB. Perspectives on the Mitral Valve. F.A. Davis, Philadelphia 1987.)

MANOVRE

Diagnosis Systolic murmur Second sound Effect of posture Amyl nitrate Phenylephrine Hypertrophic obstructive cardiomyopathy S1 S2 Variable i.e. reversed partially reversed narrow or normal ↓ ↑ ↑ Mitral incompetence a. Pure severe S1 Widely split ↑ ↓ ↑ b. Papillary muscle dysfunction EC Normal or partially reversed ↓ ↓ ↑ c. Mitral valve prolapse Normal ↓ ↓ ↑ d. Rheumatic of moderate degree S1 Slightly wide ↓ ↓ ↑ Valvular aortic stenosis Mild to mod Narrow or partially reversed ↓ ↑ – b. Marked Reversed ↑ ↓ – Ventricular septal defect S1 Slightly wide – ↓ ↑ Innocent vibratory systolic murmur Normal – – –

EC=ejection click – No change from control ↑ Degree of increase ↓ Degree of decrease

Diagrammatic representation of the character of the systolic murmur and of the second heart sound in several abnormalities. The effects of posture, amyl nitrite inhalation, and phenylephrine injection on the intensity of the murmur are shown. (With permission from Barlow, JB. Perspectives on the Mitral Valve. F.A. Davis, Philadelphia 1987.)

ALGORITMO MANOVRE

Long systolic murmur

• Increases with inspiration
  • Tricuspid regurgitation or pulmonic stenosis
• No change with inspiration
  • Increases with Valsalva or squat to stand
    • YES
      • Hypertrophic cardiomyopathy
    • NO
      • Increases with handgrip or transient arterial occlusion
        • YES
          • Mitral regurgitation or VSD
        • NO
          • Aortic stenosis

Valutazione soffio

• fase cardiaca
• intensità
• focolaio
• irradiazione
• manovre

Insufficienza mitralica

Mitrale mixomatosa

ANATOMIA PATOLOGICA

ANATOMIA PATOLOGICA

ANATOMIA PATOLOGICA

ANATOMIA PATOLOGICA