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Cardio > Auscultation / Murmurs > Flashcards

Auscultation / Murmurs Flashcards

1
Q

What murmur is heard in the aortic area / base of heart?

A

aortic stenosis

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2
Q

What type of murmur is aortic stenosis?

A

systolic murmur

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3
Q

Which murmurs are found in the pulmonic area?

A

ASD and pulmonic stenosis

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4
Q

What type of murmur is ASD?

A

systolic murmur

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5
Q

What diastolic murmurs are found at left sternal border?

A

aortic regurgitation

pulmonic regurgitation

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6
Q

What systolic murmurs are found at left sternal border?

A

HCM

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7
Q

What holosystolic murmurs are found in tricuspid area?

A

tricuspid regurgitation

VSD

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8
Q

What diastolic murmur is found in tricuspid area?

A

tricuspid stenosis

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9
Q

What holosystolic murmur is found at apex?

A

mitral regurgitation

sometimes this is just described as systolic

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10
Q

What systolic murmur is found at apex?

A

MVP

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11
Q

What diastolic murmur is found at apex?

A

mitral stenosis

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12
Q

Which murmur is crescendo-decrescendo?

A

aortic stenosis

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13
Q

What happens to heart sounds as aortic stenosis worsens?

A

crescendo-decrescendo moves later in systole

S2 heart sound becomes inaudible

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14
Q

Why does the crescendo-decrescendo move later in systole in worsening AS?

A

because as aortic stenosis worsens, it takes longer for blood to push out and lengthens time

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15
Q

Which murmur has an opening click followed by late systole murmur?

A

MVP

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16
Q

What moves the MVP murmur earlier?

A

decreased preload = earlier MVP

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17
Q

What moves the MVP murmur later?

A

increased preload = later MVP

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18
Q

Difference between S3 and S4

A

S3 = early diastole and due to rapid ventricular filling. Indicates increased LAP

S4 = late diastole and due to blood hitting a stiff LV wall. Can be due to longstanding HTN or HCM

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19
Q

Which heart sound S3 or S4 can healthy people have?

A

S3

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20
Q

“Young female, otherwise healthy” indicates what condition? What murmur should you check for? Where should you listen?

A

MVP

opening click with late systolic murmur

listen at apex

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21
Q

“Healthy young athlete with syncope” indicates what condition? What murmur should you check for? Where should you listen?

A

HCM

systolic murmur

listen at left sternal border

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22
Q

“Immigrant or pregnant” indicates what condition? What murmur should you check for? Where should you listen?

A

mitral stenosis

diastolic murmur with opening snap

listen at apex

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23
Q

“IV drug abuser” indicates what condition? What murmur should you check for? Where should you listen?

A

Tricuspid regurgitation

holosystolic murmur

listen at tricuspid area

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24
Q

What two conditions cause holocystolic murmur?

A

tricuspid regurgitation and mitral regurgitation

(also VSD)

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25
Q

What does increased inspiration cause in regard to heart sounds?

A

increased negative pressure, so increased venous return

more preload on R side = greater intensity of R sided heart sounds

also causes physiological splitting of S2 as more blood makes PV close after AV

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26
Q

What does hand grip do in general?

A

increases afterload

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27
Q

What does hand grip do to heart sounds?

A

increased afterload = more regurgitation, so increases sound of MR, AR and VSD

28
Q

What does hand grip do to MVP?

A

increased afterload = later click of MVP

29
Q

What does hang grip do to HCM?

A

increase afterload = transient increase in preload, so this will temporarily relieve HCM and decrease murmur

30
Q

What does hand grip due to aortic stenosis?

A

increase afterload = decrease aortic stenosis murmur

31
Q

What do valsava manuevers and standing up do in general?

A

they decrease preload which decreases intensity of most murmurs

32
Q

Which murmurs worsen with valsava / standing ?

A

HCM

decrease preload = less expansion = worse for HCM

33
Q

What does rapid squatting do in general?

A

increase preload by squeezing blood from veins to heart

34
Q

When does rapid squatting increase murmur?

A

increases most murmurs since there is more preload

35
Q

When does rapid squatting decrease murmur?

A

increased preload = better for HCM, decreases murmur

36
Q

What does rapid squatting due to MVP?

A

increased preload = later click of MVP

37
Q

What is another term for persistent splitting?

A

wide splitting

38
Q

What is physiological splitting?

A

on inspiration there is increased R venous return

this increase in blood means PV closes after AV

39
Q

Persistent / wide S2 splitting

A

S2 splitting occurs during expiration but is wider during expiration

this indicates a problem with anything that causes delayed conduction down right side (RBBB or pulmonary stenosis)

40
Q

Fixed S2 splitting

A

equally large split on inspiration and expiration

caused by ASD

ASD = always have venous return to right side due to the hole in the septum

41
Q

Paradoxical S2 splitting

A

during exhalation, AV is delayed in closing

reverse of physiologic splitting

caused by left sided delayed (LBBB, pacemaker, aortic stenosis, HCM)

42
Q

What does amyl nitrate do in general?

A

decreases afterload = increased contractility = decreased ESV / preload

43
Q

Which murmurs are louder with increased afterload?

A

backwards murmurs: AR, MR and VSD

44
Q

Which murmurs after lessened by increased preload?

A

HCM and MVP

45
Q

What does amyl nitrate do to HCM?

A

worsens murmur since there is less preload

(through afterload decreasing)

46
Q

Laplace’s law and when it occurs

A

states that increased pressure = increased wall thickness

this occurs in AS, since to overcome increased afterload you need increased pressure. This increase in pressure will lead to increased wall thickening

47
Q

What is the same as a S4 but with palpation?

A

presystolic heave

48
Q

What can AS predispose you to?

A

aortic aneurysm

(monitor the symptoms: syncope, angina, DOE)

49
Q

When do patients with undiagnosed MS often present?

A

normally during pregnancy due to increased blood volume and cardiac output

mitral valve cannot keep up with the increase in pressure and CO will not compensate, leads to SOB and pulmonary edema

50
Q

What relationship is often flawed to cause pathologic results?

A

CO = HR * SV

(if you can’t keep up, you’re going to have problems)

51
Q

What does mitral stenosis sound like?

A

opening snap followed by descendo diastolic murmur

52
Q

What sound indicates worse mitral stenosis?

A

less time between A2 and opening click

less time = greater left atrial pressure

53
Q

Where can you hear systolic murmur at LLSB?

A

ASD

54
Q

When does VSD murmur get more high pitched?

A

smaller hole = more high pitches

55
Q

What does hand grip do to VSD?

A

increased afterload = increased strength of murmur

56
Q

What is associated with ASD in terms of auscultation?

A

systolic murmur at LLSB

diastolic rumble

tricuspid valve closes harder = increased S1 sound

57
Q

What is associated with mitral regurgitation in terms of auscultation?

A

systolic murmur at apex

S3 gallop (if in heart failure with it)

58
Q

What causes an S3 gallop?

A

often due to heart failure

indicates increased LAP / rapid ventricular filling

59
Q

Effects of squatting on mitral regurgitation

A

squatting causes increased afterload

increased afterload pushes more fluid through regurg

also increased preload = more regurg.

60
Q

What 2 conditions can cause A2 to come quicker than P2 leading to wide splitting on expiration?

A

VSD and mitral regurgitation

causes persistent splitting

61
Q

What 2 conditions can lead to paradoxical split?

A

anything that causes A2 to consistently come after P2

would occur in: aortic stenosis, LBBB or HCM

62
Q

What else can cause persistent splitting besides mitral regurg / VSD?

A

something that persistently causes the P2 sound to come later

this would include: LBBB, pulmonary HTN or pulmonic stenosis

63
Q

What would an ionotropic agent do to MVP?

A

ionotropic = increased contractility= decreased ESV

decreased volume = earlier click of MVP

64
Q

What does amyl nitrite do?

A

it dilates arteries, so it is primarily concerned with decreasing afterload

however you can think that there is less volume for your OWN understanding … in reality this is not as true

65
Q

Where is the tricuspid area physiologically?

A

at the left middle / lower sternal border

66
Q

What happens to pulse pressure in aortic regurgitation?

A

decreased pulse pressure in aortic regurg!

67
Q

Opening click at the beginning of systole that does not move with maneuvers

A

Bicuspid aortic valve

Cardio (8 decks)

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