258.2 ð åèç
258.2.0.1 å¿ è â JVP
- Right IJV at 30-45°
- Vertical height + 5 cm = JVP
- Normal < 8-9 cm H2O
- Elevated: HF, tamponade, RV failure, PHTN
- Kussmaul sign: JVP rises with inspiration (constrictive pericarditis, severe RV failure)
258.2.0.2 å¿ è â Arterial Pulse Patterns
- Pulsus parvus et tardus: AS
- Water-hammer / Corrigan: AR
- Pulsus alternans: severe LV dysfunction
- Pulsus paradoxus (> 10 mmHg drop with inspiration): tamponade, severe asthma, severe pericarditis
- Pulsus bisferiens: HOCM, severe AR
- Asymmetric pulses: aortic dissection
258.2.0.3 å¿ è â Heart Sounds
- S1: loud (MS, hyperdynamic, short PR); soft (severe MR, long PR)
- S2: fixed splitting = ASD; paradoxical = LBBB / severe AS / HOCM
- S3: HF, MR, AR, VSD (pathologic in adult); normal in young + pregnant
- S4: LVH (HTN, AS, HCM), acute MI, diastolic dysfunction; disappears in AF
- Opening snap: mitral stenosis
- Ejection click: bicuspid aortic valve
- Mid-systolic click: MVP
258.2.0.4 å¿ è â Murmurs Systolic
| Murmur | Key Features |
|---|---|
| AS | Crescendo-decrescendo, R 2nd ICS â carotid, late-peaking in severe, parvus et tardus |
| MR | Holosystolic, apex â axilla, blowing |
| TR | Holosystolic, L lower sternal border, Carvallo sign (â with inspiration) |
| VSD | Holosystolic, L lower sternal border, harsh |
| HOCM | Crescendo-decrescendo, L lower sternal border, Valsalva â, squat â |
| MVP | Mid-systolic click + late systolic murmur, Valsalva earlier |
258.2.0.5 å¿ è â Murmurs Diastolic
- AR: decrescendo, L sternal border 3rd-4th ICS, sitting + leaning forward + breath held
- MS: opening snap + diastolic rumble + presystolic accentuation, apex with bell