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all right very heart diseases where are
we and what are we doing my goodness
there is so much discuss here but mu
approaches one valve at a time and as we
do so we will dissect every single
aspect of that Vavilov heart disease so
that by the time you've gotten through
this you know who your patient is what
they're presenting with and understand
is the pathogenesis of what got us here
in the first place let's begin well here
once again is that chest how important
is this chest quite we talked about the
aortic area I want you to point to it
where am i a right parasternal second
intercostal space why because of the
anatomy of your aorta take a look at the
arch and so therefore that is where you
normally would hear your aortic valve if
you're dealing with a systolic murmur
we'll take a look at aortic stenosis and
I told you about that patient that's
feeling tired fatigued maybe a little
bit of chest pain with exertion let's
talk about that for one second here if
it is air texture notice what's causing
this chest pain it's not my car D
infarction but it's effective with the
aortic stenosis as he left ventricle is
having a hard time kicking against that
increased after load and so therefore
the left ventricle is lifting weights
once upon a time when I was younger and
I was lifting weights I was undergoing
hypertrophy of my biceps nowadays it's
more about atrophy but as far as the
left ventricle is concerned it is also
lifting weights what are the weights in
this environment the stenotic Eric valve
so what's the hypertrophy that were
referring to in left ventricle it's the
fact that it's concentric hypertrophy as
I clear and the reason I bring all this
up is because with that increased
thickness of the myocardium that is a
lot of myocardial in which blood has to
continue supplying oxygen so what if it
was inadequate oxygenation isn't that
the definition of angina good let's
continue we also looked at the
second intercostal space left
parasternal
and that be the pulmonic area i want you
to point to that and here would be some
type of pulmonic stenosis here i want to
once again reiterate the atrial septal
defect and why it would be a diastolic
murmur that would be best heard by the
fifth intercostal space left parasternal
or best heard as a flue murmur through
your second intercostal space left
parasternal because there's a lot of
blood on your right side right a true
septal defect now common causes well
were you talked about austin secundum
and that would be congenital but what if
a child was born with unfortunately one
of the most common causes of acquired
intellectual disability in the united
states is alcohol acquired so this is
called fetal alcohol syndrome it could
it be ASD sure it can and with all this
blood moving from the left atrium to the
right atrium you increase the amount of
blood and so the tricuspid valve now
feels overwhelmed and during your
diastole the tricuspid valve will open
and with all this blood which is
pathologically being introduced into the
right atrium is now moving forward
flowing in a turbulent nature into the
right ventricle or are you seeing this
and therefore atrial septal defect will
be a diastolic murmur now at some point
with all this blood
it will also hit the pulmonic valve
clinically speaking you expect to hear a
murmur in the pulmonic region as well
with ASD so this is a picture that we
looked at earlier and this is a picture
that we're reiterating what we're going
to do throughout this lecture series is
then delineate and distinguish each
Vavilov heart disease and you'll be in
good hands
trust me
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you