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Anatomy of external of the heart
1. Boarders
  1. Left
    1. LV
  2. Right
    1. RA
  3. Lower
    1. Two ventricles mainly right
  4. Upper
    1. Two atria mainly left
2. Surface
  1. Sternocostal
    1. Both atria and ventricles
    2. Divided by coronary groove
  2. Diphramatic
    1. Two ventricles mainly left
  3. Left
    1. LV
  4. Right
    1. RA
3. Grooves
  1. Atrioventicular groove
    1. R and L coronary arteries
  2. Posterior interventicular groove
    1. Posterior interventicular artey
    2. Great cardiac vein
  3. Anterior interventicular groove
    1. Anterior interventicular artery
    2. Middle cardiac vein
  4. interatrial groove
4. Surface anatomy
5. Auscultatory locations of the valves
Heart sounds
1. Normal
  1. S1
    1. Closure of mitral and tricuspid valve
    2. Lub
  2. S2
    1. Closure of aortic and pulmanory valves
    2. Dub
2. Abnormal
  1. S3
    1. Venticular filling
  2. S4
    1. Atrial contraction
  3. Heart murmurs
    1. Holes in the heart or cardiac shunts. Heart valve abnormalities. Valve calcification. Endocarditis. Rheumatic fever.
    2. causes
Cardiac cycle
Causes of Fainting
1. Decreased blood flow to brain
2. Neurally Mediated
3. Orthostatic
4. Drug-induced
5. Cardiac
Causes of Chest Pain
1. Heart-related causes
  1. eg. Myocardial infarction
2. Lung-related causes
  1. eg. Pulmonary embolism
3. Digestive causes
  1. eg. GERD
4. Muscle and bone causes
  1. eg. Costochondritis
Valvular Heart Diseases
1. Degenerative Valve Disease
  1. Calcific aortic stenosis
    1. dystrophic calcification, degeneration and stenosis of the aortic valve
    2. Murmur radiates to neck
  2. mitral valve prolapse
    1. leaflets prolapse into the left atrium when the left ventricle contracts.
    2. chordea tendinea becomes long and thin
    3. Midsystolic click then systolic murmur
2. Rheumatic Valvular Disease
  1. Acute rheumatic fever
  2. Chronic rheumatic disease
    1. Is an irreversible valve scaring that will cause stenosis of the valves with a fish mouth appearance.
3. Infective Endocardaitis
4. Noninfected vegetations
  1. Nonbacterial thrombotic endocarditis
    1. form of endocarditis in which small sterile vegetations are deposited on the valve leaflets.
  2. Libman-Sacks endocrditis
    1. Endocarditis associate with SLE
5. Carcinoid Heart Disease
  1. Carcinoid tumors are rare neuroendocrine malignancies. mostly arising within the gastrointestinal system.
6. Prosthetic Cardiac Valve
  1. Bio-prosthetic valves
    1. Structural deterioration, calcification.
    2. Infective endocarditis
  2. mechanical valves
    1. Thrombi
    2. Infective endocarditis
    3. Hemolysis
7. Investigations
  1. Electrocardiography
    1. in case of venticular hypertrophy
      1. left axis deviation
      2. Prominent u waves
      3. atrial enlargement
      4. st segment depression and elevation
      5. R peak times of more than 35mm
  2. Echocardiography
    1. in case of venticular hypertrophy
      1. Echo-dense aortic valve with no cusp motion
      2. Maximal aortic cusp separation < 8 mm
      3. LV hypertrophy
      4. Transvalvular gradient > 40 mmHg
  3. Chest X-Ray
    1. help diagnose and monitor conditions such as pneumonia, heart failure, lung cancer, tuberculosis, sarcoidosis
  4. Cardiac Catheterization
    1. inserted in an artery or vein in your groin, neck or arm
Aortic valve replacement
1. open-heart surgery
2. Blood is circulated outside of the body through a machine to add oxygen to it (cardiopulmonary bypass or heart-lung machine)

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