SEMIO CH 12-13 TRIGGER

S1 =

→ 1ST HEART SOUND

→ CLOSING OF A.V VALVES

→ BEGINNING OF THE SYSTOLE

S2 =

→ 2ND HEART SOUND

→ CLOSURE OF AORTIC + PULMONARY VALVES

→ BEGINNING OF THE DIASTOLE

MURMUR =

ABNORMAL SOUND DUE TO TURBULENT BLOOD FLOW

2 DIFFERENT TYPES OF MURMUR :

CARDIAC MURMUR

ARTERIAL MURMUR

CARDIAC MURMUR ASSOCIATED W/ ? CAUSED BY ?

ASSOCIATED W/ VALVULAR HEART DISEASE

→ CAUSED BY STENOSIS / REGURGITATION

ARTERIAL MURMUR ASSOCIATED W/ ?

ARTERIAL STENOSIS

STENOSIS DEF

VALVE OPENING IS NARROWED → BLOOD HAS DIFFICULTY TO PASS

REGURGITATION DEF

VALVE DOES NOT CLOSE PROPERLY → BLOOD FLOWS BACKWARD

TEST FOR → ELECTRIC ACTIVITY OF THE HEART ?

EKG / ECG

TEST FOR → OVERALL THORACIC IMAGE

CHEST X RAY

TEST FOR → ULTRASOUND OF THE HEART

ECHOCARDIOGRAPHY

TEST FOR → BLOOD FLOW ASSESSMENT

DOPPLER

TEST FOR → CORONARY ARTERY VISUALIZATION

MULTISLICE CORONARY CT

TEST FOR → DETAILLED CARDIAC ANATOMY

MRI

TEST FOR → VEIN IMAGING

PHLEBOGRAPHY

TRIGGER SA NODE

→ NATURAL PACEMAKER

→ BEGINNING OF ELECTRICAL IMPULSE

TRIGGER AV NODE

ELECTRICAL CONDUCTION BETWEEN ATRIAS AND VENTRICULES

P WAVE =

ATRIAL DEPOLARIZATION

PR SEGMENT

AV NODE

QRS COMPLEX

VENTRICULAR DEPOLARIZATION

T WAVE

VENTRICULAR REPOLARIZATION

ATHEROSCLEROSIS

FATTY MATERIAL UNDER THE INTIMA OF MEDIUM-LARGE ARTERIES

GROWTH OF THE FATTY MATERIAL CAUSES

↓ OF THE ARTERIAL LUMEN

↓ OF THE ARTERIAL LUMEN CAUSES

STENOSIS

STENOSIS CAUSES

BLOOD FLOW ↓

BLOOD FLOW ↓ CAUSES

ISCHEMIA

ATHEROSCLEROSIS → FAST OR SLOW PROGESSION ?

SLOW ARTERIAL DISEASE

INTIMAL THICKENING IN HOW MANY TIME ?

10-20 ANS

1ST SYMPTOMS OF ATHEROSCLEROSIS ?

35-40 ANS

6 MAINS ARTERIES AFFECTED ?

CORONARY

CAROTID / CEREBRAL

ILIAC / FEMORAL / POPLITEAL

HEART AFFECTED WHEN WHICH ARTERY AFFECTED ?

CORONARY

BRAIN AFFECTED WHEN WHICH ARTERY AFFECTED ?

CAROTID / CEREBRAL

LOWER LIMBS AFFECTED WHEN WHICH ARTERY AFFECTED ?

ILIAC / FEMORAL / POPLITEAL

4 MAIN RISK FACTORS ATHEROSCLEROSIS ?

HIGH CHOLESTEROL + HYPERTENSION + SMOKING + DIABETE

HYPERCHOLESTEROLEMIA VALUE

WHEN LDL ABOVE 160

OR TOTAL CHOLESTEROL ABOVE 200

HYPERTENSION VALUE

WHEN SYSTOLIC BLOOD P° ≥140

WHEN DIASTOLIC BLOOD P° ≥90

CHYLOMICRONS TRANSPORTS →

TRIGLYCERIDES

LDL TRANSPORTS →

CHOLESTEROL

VLDL TRANSPORTS →

TRIGLYCÉRIDES

HDL TRANSPORTS →

CHOLESTEROL

STEP 1 ATHEROSCLEROSIS

ENDOTHELIAL DYSFUNCTION

STEP 2 ATHEROSCLEROSIS

LDL CROSSES ENDOTHELIUM → OXYDATION OF LDL

COMMENT LE FATTY STREAK SE FORME T’IL ?

APRES OXYDATION DU LDL → MONOCYTES SONT ATTIRÉS → SE DIFFÉRENCIENT EN MACROPHAGES → PHAGOCYTENT LES LDL OXYDÉS → DEVIENNENT DES FOAM CELLS → ACCUMULATION DE FOAM CELLS → FATTY STEAK

FATTY STREAK DEVIENT ENSUITE ?

FIBROUS PLAQUE

COMMENT FIRBOUS PLAQUE SE FORME T’ELLE

APRÈS ACCUMULATION DE FOAM CELLS → MIGRATION DE VASCULAR SMOOTH MUSCLE CELLS → PRODUISENT COLLAGEN + EXTRACELLULAR MATRIX → FORMENT UNE FIBROUS CAP AU DESSUS DU FATTY STREAK

TRIGGER FIBROUS PLAQUE

FATTY STREAK + VASCULAR SMOOTH MUSCLE CELLS + COLLAGEN + MATRIX

ON PARLE DE COMPLICATED PLAQUE QUAND ?

FIBROUS CAP FISSURE / RUPTURE

PROBLEME ENTRAINÉ PAR PLAQUE FISSURE ?

RUPTURE DE LA PLAQUE EST CONSIDÉRÉE PAR LE CORPS COMME UNE LÉSION → COAGULATION DE LA RUPTURE → FORMATION D’UN THROMBUS AU NIVEAU DE LA PLAQUE ROMPUE → PARTIAL / COMPLETE VESSEL OBSTRUCTION

VESSEL OBSTRUCTION ENTRAINE →

ACUTE ISCHEMIA

A QUEL MOMENT LES SYMPTOMES DE L’ATHEROSCLEROSIS APPARAISSENT ?

QUAND L’ARTERIAL STENOSIS EST SUPÉRIEURE À 70%

DIFFERENCE STABLE / UNSTABLE PLAQUE

STABLE PLAQUE → COLLAGEN RICH + HARD PLAQUE

UNSTABLE PLAQUE → LIPID RICH + SOFT PLAQUE

PARTIAL ISCHEMIA

LUMEN NOT COMPLETLY BLOCKED → BLOOD CAN STILL PASS

COMPLETE ISCHEMIA

100 % LUMEN OBSTRUCTION

TRIGGER CORONARY + STABLE PLAQUE + PARTIAL ISCHEMIA

STABLE ANGINA

TRIGGER CORONARY + COMPLETE ISCHEMIA + COMPLICATED PLAQUE

ACUTE CORONARY SYNDROME

TRIGGER BRAIN / CAROTID + COMPLICATED PLAQUE + COMPLETE ISCHEMIA

TRANSIENT ISCHEMIC ATTACK / CEREBRAL INFRACTION

TRIGGER LOWER LIMBS ARTERY + COMPLICATED PLAQUE + COMPLETE ISCHEMIA

LOWER LIMB GANGRENE

( NO BLOOD FLOW → SEVERE ISCHEMIA → NECROSIS → GANGRENE)

TRIGGER LOWER LIMBS ARTERY + NON COMPLICATED PLAQUE + PARTIAL ISCHEMIA

INTERMITTENT CLAUDICATION

(SYMPTOMS DURING WALK BECAUSE INSUFFISANT BLOOD FLOW IN MUSCLES)