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PCMIII Ex2 > Abnormal Heart Sounds > Flashcards

Abnormal Heart Sounds Flashcards

1
Q

Cardiac auscultation listening posts

A

Aortic valve = right 2nd ICS at SB

Pulmonic valve = left 2nd ICS at SB

Tricuspid valve = left 4th ICS at SB

Mitral valve = left 5th ICS at MCL

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2
Q

Grading of heart murmurs

A

Grade 1 = very faint

Grade 2 = quiet, soft, easily heard with stethoscope

Grade 3 = moderately loud

Grade 4 = loud with palpable thrill

Grade 5 = very loud with thrill; can hear with stethoscope

Grade 6 = heard without stethoscope

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3
Q

Systolic murmurs occur between ___ and ____

Diastolic murmurs occur between ___ and ____

A

S1; S2

S2; S1

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4
Q

What does S1 represent?

A

Closure of tricuspid valve and mitral valve

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5
Q

What does S2 represent?

A

Closure of aortic valve and pulmonic valve — may split with inspiration

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6
Q

Describe S3 heard in some pts

A

Dull, low pitch; best heard with bell (Kent-Tuck-y)

Physiologic in children, young adults

Pathologic in older adults = heart failure

Ventricular gallop

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7
Q

Describe S4 heard in some pts

A

Dull, low pitch; best heard with bell (Ten-Nes-See)

Forceful atrial contraction against stiffened low compliant ventricle

Atrial gallop

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8
Q

What are the systolic murmurs?

A 
Mitral regurg (MVP)
Tricuspid regurg
Aortic stenosis
Pulmonic stenosis
VSD
Aortopulmonary shunts
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9
Q

What are the diastolic murmurs?

A 
Aortic regurg
Pulmonic regurg
Mitral stenosis
Tricuspid stenosis
Atrial myxoma
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10
Q

What are the continuous murmurs?

A

PDA — machine-like

AV fistula

ASD with high LA pressure

Coarctation

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11
Q

What are the most common valvular heart diseases encountered today?

A

Degenerative (senile calcification)

Myxomatous degeneration (MVP)

Congenital (bicuspid aortic valve)

[decline in incidence of rheumatic valvular disease]

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12
Q

Chronic vs. acute etiologies of mitral regurg

A

Chronic:
MVP — Most common etiology
Mitral annular calcification

Acute:
Rupture of chordae tendinae
Rupture of papillary muscle
Ischemic Papillary muscle dysfunction (CAD/MI — next MCC of MR)
Infective endocarditis
Valve perforation
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13
Q

Symptoms of MR

A

Asymptomatic years —> fatigue, DOE, palpitations

Acute; volume overload/orthopnea, PND, RHF/LHF

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14
Q

PE findings with MR

A

Systolic murmur — blowing, prominent at apex; radiates into left axilla

Loudness of murmur correlates with severity

Decreased S1 or normal; may have systolic click

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15
Q

Sx of mitral stenosis

A

Arise in 4th decade

DOE, cough, orthopnea, PND, pulmonary edema, hemoptysis, arterial emboli, A.fib

Ortner syndrome: hoarseness d/t compression of left recurrent laryngeal n

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16
Q

mitral stenosis findings on PE

A

Malar flush — ruddy cheeks, blue facies

Increase S1; opening snap (OS) after S2

Rumbling, diastolic murmur — low pitched; best heard at apex. Use bell

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17
Q

Etiologies of aortic stenosis

A

Degenerative (calcific, senile, fibrosis, or sclerosis)

Congenital bicuspid aortic valve (BAV) - 1% of population

Rheumatic or postinflammatory scarring

[normal AoV area is 4.0 cm]

18
Q

Symptoms of aortic stenosis

A

Arise in 6th decade

Exertional dyspnea, angina, syncope, heart failure

Without tx, prognosis is poor — most die w/i 3 years of developing syncope and w/i 2 years of onset of HF

19
Q

Pathophysiology of aortic stenosis

A

Obstruction leads to pressure overload; LVH, increase LVED pressure

Gradient across valve

[severe AS if AoV <1 cm]

20
Q

Aortic stenosis on PE

A

Narrow pulse pressure; decreased SV and systolic pressure

Delayed pulses - Parvis (weak-small)/Tardus (late)

Systolic murmur, harsh, 2nd ICS RSB; radiates into suprasternal notch/carotids

21
Q

What is the Gallavardin phenomenon?

A

AS murmur radiates to apex (like MR)

22
Q

Causes of acute vs. chronic aortic regurg

A

Acute: IE, aortic dissection, BAV

Chronic: Syphilis, ankylosing spondylitis

23
Q

PE findings with aortic regurg

A

Diastolic decrescendo murmur, 3rd ICS LSB

Systolic murmur usually present, soft

Wide pulse pressure; bisferious pulse

De Musset sign, Corrigan’s pulse, Quincke’s pulse, Traube’s sign, Durozrey’s sign, Hill’s sign

Austin Flint murmur — can mimic mitral stenosis

24
Q

Conditions associated with tricuspid regurg

A

Pulmonary HTN, inferior MI/RV infarct

25
Q

What murmur is associated with prominent V wave in JVP?

A

Tricuspid regurg

26
Q

PE findings with tricuspid regurg

A

Blowing systolic murmur LSB; increase with inspiration (Carvallo’s sign)

27
Q

Murmur associated with mitral stenosis, tricuspid regurg, and RHD

A

Tricuspid stenosis

28
Q

Tricuspid stenosis is associated with prominent ____ wave in JVP, ascites, and potentially pulsatile hepatomegalia

A

A

29
Q

PE findings with tricuspid stenosis

A

Diastolic murmur LSB; increase with inspiration (Carvallo’s sign) and decrease with expiration and valsalva

30
Q

Most cases of pulmonic regurg are due to ________

A

Pulmonary HTN

31
Q

Pulmonic regurg on PE

A

Diastolic, blowing murmur 2nd ICS LSB (Graham Steel)

32
Q

Pulmonic stenosis can cause _____ and ____

A

Angina; syncope

33
Q

PE findings with pulmonic stenosis

A

2nd-3rd ICS, LSB — radiates toward left shoulder and increases on inspiration/RVH

34
Q

Which of the following presents with crescendo-decrescendo systolic murmur, often with systolic thrill, typically loudest at second right ICS?

A. Mitral stenosis
B. Mitral regurgitation
C. Mitral valve prolapse
D. Aortic stenosis
E. Aortic regurgitation
F. Tricuspid regurgitation
A

D. Aortic Stenosis

35
Q

Which of the following presents with mid or late systolic click(s) followed by late systolic murmur at apex; exaggerated by valsalva maneuver and reduced by squatting?

A. Mitral stenosis
B. Mitral regurgitation
C. Mitral valve prolapse
D. Aortic stenosis
E. Aortic regurgitation
F. Tricuspid regurgitation
A

C. Mitral Valve Prolapse

36
Q

Which of the following presents with severe RV failure with edema, hepatomegaly, and prominent v waves in jugular venous pulse with rapid y descent, as well as a systolic murmur heard along lower left sternal edge that increases with inspiration?

A. Mitral stenosis
B. Mitral regurgitation
C. Mitral valve prolapse
D. Aortic stenosis
E. Aortic regurgitation
F. Tricuspid regurgitation
A

F. Tricuspid regurgitation

37
Q

Which of the following presents with fatigue, weakness, and exertional dyspnea as well as loud holosystolic murmur at apex, possibly with brief early-mid-diastolic murmur?

A. Mitral stenosis
B. Mitral regurgitation
C. Mitral valve prolapse
D. Aortic stenosis
E. Aortic regurgitation
F. Tricuspid regurgitation
A

B. Mitral regurgitation

38
Q

Which of the following presents with exertional dyspnea and awareness of forceful heartbeat, angina pectoris, and signs of LV failure with blowing decrescendo diastolic murmur along the left sternal border?

A. Mitral stenosis
B. Mitral regurgitation
C. Mitral valve prolapse
D. Aortic stenosis
E. Aortic regurgitation
F. Tricuspid regurgitation
A

E. Aortic regurgitation

39
Q

Which of the following presents with opening snap followed by diastolic rumbling murmur with presystolic accentuation when in sinus rhythm?

A. Mitral stenosis
B. Mitral regurgitation
C. Mitral valve prolapse
D. Aortic stenosis
E. Aortic regurgitation
F. Tricuspid regurgitation
A

A. Mitral stenosis

40
Q

What is ortner syndrome and what valvular dz is it associated with?

A

Hoarseness d/t compression of left recurrent laryngeal n.; associated with mitral stenosis when left atrium enlarges and compresses on that nerve

41
Q

Acute ____ ____ can present with cardiogenic shock

A

Mitral regurgitation

PCMIII Ex2 (10 decks)

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