Teaching Points:

• Normal Intracardiac Pressures
  • Right Atrium – 0-6
  • Right Ventricle: 15-30/0-6
  • Pulmonary Artery: 15-30/6-12
  • Left Atrium: 6-12
  • Left Ventricle: 100-130/6/12
• Heart failure exacerbations first results from elevated Left ventricular End Diastolic Pressure (LVEDP).
• Increased LVEDP –> increased LA pressures –> increased pulmonary pressure
  • Most common cause of right heart failure is left heart failure
• Mitral Stenosis heart sounds
  • Loud S1
    • Due to forceful closure of mitral valve.
  • Opening Snap (OS) with diastolic rumbling after S2
    • OS occurs later than along the cycle compared to a split S2 sound.
• Most common cause of mitral stenosis is rheumatic heart disease.
• Patients with mechanical prosthetic valves should be on Coumadin for anticoagulation due to increased thrombotic risk.
• Newer anticoagulants including anti-X and anti-II inhibitors have been shown to increase bleeding and thrombotic risks.