MURMURS (soplos)

Stenosis = problem in opening the valve

Regurgitation = problem in closing the valve

 

Need to know where valves are heard best – right 2^ndICS (aortic valve), left 2^nd ICS (pulmonic), left parasternal border (tricuspid), apex (mitral) – this isn’t necessarily where the valve is, but where the noise is heard the best.

 

Maneuvers & Murmurs

Hemostasis

 

Arachidonic Acid metabolism

SOME FORMULAS

• CPP = MAP - IP
(Cerebral Perfusion Pressure) (Mean Arterial Pressure) (Intracraneal Pressure)
• MAP = CO x TPR
(Cardiac Output) (Total Peripheral Resistance)
• CO = HR x SV
(Heart Rate) (Stroke Volume)
• TPR = Viscocity / radius4



Some Respiratory Formulas

• VTotal = VDead Space + VAlveolar • Vmin = TV x RR • TV = 10-15 cc/Kg

Example: • VTotal = VDead Space + VAlveolar      5000             40%              ??  = 3000 • Vmin = TV x RR      5000      500   x  10 • TV = 10-15 cc/Kg

PTH DISORDERS & LEUKEMIAS AGE BRACKETS

CARDIAC CYCLE

•S1 begining of systole → Mitral & Tricuspide closure

•S2 begining of diastole.→ Aortic & Pulmonary closure  Variation with Respiration (P2 separates away from A2 b/c more blood is comming into the rigth heart, so the valve closes a little bit later). 
•S3 occurs in early diastole during rapid ventricular filling (after MV opens). Associated with ↑ filling pressures commonly in dilated ventricles (vol overloaded). Normal in kids and pregnant♀.
•S4 occurs in late diastole. Associated with ventricular hypertrophy (concentric HPY). High atrial pressure (Left atrium must push against stiff LV).

○ Aortic Stenosis → EC (when AV opens)
○ Mitral Prolapse → MC (sudden tensing of chordae tendinae)
○ Mitral Stenosis → OS (tensing of chordae tendinae.
EC= Ejection click, MC= Midsystolic click, OS= Opening snap
Heart Sounds
Auscultation Assistant

Type	Inspiration	Expiration	Cause
Normal or physiologic

Tensor Fascia Lata / Sartorius

BLOOD VESSEL INNERVATION

NICOTINIC RECEPTORS

BLADDER & LUNGS INNERVATION

KIDNEY AND PANCREAS INNERVATION (Mnemonic)

The way Vivi recalls the kidney and pancreas innervation is assigning the number 1 to the organ kidney (because is the #1 arterial pressure regulator organ) and #2 to the pancreas (because type II Diabetes is the most common diabetes ja ja)

Both organs have α and ß receptors

In general α receptors in these two organs decrease and ß receptors increase secretion/release of its hormones.

There you go!

Kidney:
α1 receptors ↓ Renin Release
ß1 receptors ↑ Renin Release

Pancreas:
α2 receptors ↓ Insulin Secretion
ß2 receptors ↑ Insulin Secretion

MUSCARINIC RECEPTORS

Reflex Tachycardia & Reflex Bradycardia mediated by:
Stimulation of B1 receptors (Tachy) & M2 receptors (Brady)

B2 receptor blockers contraindications: No in Asthmatics, Diabetics (B1,B2), Spastic Disorders (Prinzmetal Angina, Raynaud Phenomenon)