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Sam: Clin Assess Cardio > Bates-Murmurs > Flashcards

Bates-Murmurs Flashcards

1
Q

Is S1 softer or louder at the base?

A

Softer!

Right and left 2nd interspaces

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2
Q

Is S1 softer or louder at the apex?

A

Often, but not always louder.

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3
Q

When is S1 accentuated?

A

Tachycardia, rhythms with a short PR interval, and high cardiac output states (exercise, anemia, and hyperthyroidism)

Mitral stenosis.

In these conditions, the mitral valve is still open wide at the onset of ventricular systole and then closes quickkly

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4
Q

When is S1 diminished?

A

First-degree heart block.

Also when the mitral valve is calcified and relatively immobile, as in mitral regurg AND when left ventricular contractility is markedly reduced, as in heart failure or coronary heart disease.

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5
Q

What are the two kinds of extra heart sounds in systole?

A
  1. Early ejection sounds

2. Clicks, commonly heard in mid-and late systole

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6
Q

What are systolic clicks usually caused by?

A

Mitral valve prolapse

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7
Q

Where do we listen for mitral valve prolapse?

A

With our DIAPHRAGM, we listen at or medial to the apex, but also at the lower left sternal border

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8
Q

Do we want our patients to squat or stand when listening for mitral prolapse?

A

STAND! Squatting delays the click and murmur, standing moves them closer to S1

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9
Q

When will you diagnose PHYSIOLOGIC S3?

A

Frequently in children and in young adults to the age of 35 or 40. It is also common during the last trimester of pregnancy

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10
Q

When does the physiologic S3 occur?

A

Diastole during rapid ventricular filling, is is later than the opening snap, dull and low in pitch, and heard best at the apex in the left lateral decubitus position.

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11
Q

When does an S4 sound occur?

A

Just before S1

Commonly called an atrial sound or atrial gallop

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12
Q

How do you describe an S4 murmur?

A

Dull, low in pitch, and heard better with the bell

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13
Q

When is an S4 occasionally normal?

A

In trained athletes and in older age groups

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14
Q

When it S4 most commonly due to?

A

Increased resistance to ventricular filling following atrial contraction

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15
Q

What may cause S4 (left-sided?

A

Hypertensive heart disease, myocardial ischemia, aortic stenosis, and cardiomyopathy

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16
Q

Where is S4 best heard?

A

Best at the apex in the left lateral position. May sound like Tennessee.

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17
Q

Where do we listen for mitral regurg?

A

Apex

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18
Q

Where does mitral regurg radiate?

A

To the left axilla, less often to the sternal border

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19
Q

How would you describe the intensity of mitral regurg?

A

Soft to loud; if loud, associated with an apical thrill

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20
Q

Pitch of mitral regurg?

A

Medium to high

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21
Q

Quality of mitral regurg?

A

Harsh, holosystolic

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22
Q

How does it sound different from tricuspid regurg?

A

Does not become louder in inspiration

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23
Q

What are the most common kinds of heart murmurs?

A

Midsystolic ejection murmurs

  1. They may be innocent, without any detectable physiologic or structural abnormality
  2. Physiologic, form physiologic changes in body metabolism
  3. Pathologic–arising from a structural abnormality in the heart or great vessels
24
Q

Where do we often listen for innocent murmurs?

A

2nd to 4th left interspaces between the left sternal border and the apex

25
Q

Do innocent murmurs radiate?

A

Meh, not really

26
Q

How would the intensity of innocent murmurs be described?

A

Grade 1 to 2, possibly 3

27
Q

Pitch of innocent murmurs?

A

Soft to medium

28
Q

Quality of innocent murmurs?

A

Variable

29
Q

What happens to innocent murmurs when patient sits?

A

usually decrease or disappear

30
Q

Where do we listen for aortic stenosis?

A

Right 2nd interspace

31
Q

Where does aortic stenosis radiate?

A

Often to the carotids, down the left sternal border, even to the apex

32
Q

How would you describe the intensity of aortic stenosis?

A

Sometimes soft, but often loud with a thrill

33
Q

Pitch of aortic stenosis?

A

Medium, harsh; crescendo-decrescendo may be higher at the apex

34
Q

Quality of aortic stenosis?

A

Often harsh; may be more musical at the apex

35
Q

When is aortic stenosis heard best?

A

Patient sitting and leaning forward

36
Q

Where do we hear aortic regurg?

A

2nd to 4th left interspaces

37
Q

Where does aortic regurg typically radiate?

A

If loud, to the apex, perhaps to the right sternal border

38
Q

Intensity of aortic regurg?

A

Grade 1 to 3

39
Q

Pitch of aortic regurg?

A

High, use the diaphragm

40
Q

Location of mitral stenosis?

A

usually limited to the apex

41
Q

Radiation of mitral stenosis?

A

Little or none

42
Q

Intensity of mitral stenosis?

A

Grade 1 to 4

43
Q

Pitch of mitral stenosis?

A

Decrescendo low-pitched rumble. Use the bell!

44
Q

Where should we place the bell of the stethoscope when listening for mitral stenosis?

A

Placing the bell exactly on the apical impulse, turning the patient into a left lateral position and mild exercise all make the murmur audible. It is heard better in exhalation.

45
Q

When do we hear venous hum?

A

Continuous murmur without a silent interval. Loudest in diastole.

46
Q

How do we describe pericardial friction rub?

A

Scatchy, scraping

47
Q

Pitch of pericardial friction rub?

A

High

48
Q

Which of our murmurs has a blowing decrescendo quality?

A

Aortic Regurg

49
Q

Which of our murmurs is described as a low-pitched rumble?

A

Mitral Stenosis

50
Q

Which of our murmurs is referred to as holosystolic?

A

Mitral Reurg

51
Q

Which of our murmurs has a crescendo-decrescendo quality?

A

Aortic stenosis

52
Q

If a murmur is radiating to the carotids, which are we thinking of?

A

Aortic stenosis

53
Q

What can be described as lub-click-dub?

A

Mitral prolapse

54
Q

If we hear a murmur better with the patient and sitting and leaning forward, what is it likely to be?

A

Aortic Regurg

55
Q

We use the bell to listen to what murmur?

A

Mitral stenosis

Sam: Clin Assess Cardio (2 decks)

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