PAGE INTERPRETATION| Tutorial D-1 CVS130110110177|Gabriella Chafrina| 09/10/13Dsypnea on Exertion (DON) -Definition: difficulty breathing while performing a physical ac tivity. -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 le ading 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 c losing of AV valve, especially mitral valve (because pressure in LV > pressure in RV) -Etiology: forceful closure of mitral valve -Pathophy siology: high pressure gradient between the atrium and ventricle mobile portions of mitral valve leaflets widely separated throughout diastole at onset o f 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
