Car 8 - Diastolic Heart Murmurs Flashcards
What are three keys clues in identifying heart sounds?
Clinical scenario. Location. Systolic or diastolic.
In what location of the chest do we hear best the Aortic valve?
Right side, second intercostal space. Close to the sternum.
In what location of the chest do we hear best the pulmonic valve?
At the 2nd intercostal, left side. Close to the sternum.
In what location of the chest do we hear best the tricuspid valve?
In the 4th intercostal, left side. Close to the sternum.
In what location of the chest do we hear best the mitral valve?
In the fifth intercostal line, left side. Midclavicular line.
What four heart sounds are considered benign where there is no evidence of disease?
Split S1. Split S2 on inspiration. S3 heart sound in a patient less than 40y.o. Early, quiet systolic murmur.
Wha are the four causes of diastolic murmurs?
Mitral stenosis. Tricuspid stenosis. Aortic regurgitation. Pulmonic regurgitation.
What are the four causes of Systolic murmurs?
Aortic stenosis. Pulmonic stenosis. Mitral regurgitation. Tricuspid regurgitation.
What does breathing do to the murmurs during auscultation?
During inspiration, it causes negative interthoracic pressure, which pulls blood from vena cava into the right atrium, causing more right atrium filling. Therefore tricuspid murmurs become louder during inspiration. And mitral mumurs become louder with expiration. [E in lEft, louder in Experiation].
What does Hand grip manuever do to the murmurs during auscultation?
The hand grip manuever, where the patient grips his hands for a minute, increases systemic vascular resistance (^SVR) which increases afterload. This makes mitral regurgitation louder.
What does Valsalva maneuver do to the murmurs during auscultation?
This increases intrathoracic pressure, reduces venous return to the right side of the heart, also reduces systemic blood pressure. This reduces preload and afterload, therefore makes most heart murmurs quieter. However, makes the murmur of hypertrophic cardiomyopathy louder.
What are 4 clinical clues for aortic regurgitation?
Left side of the sternum. Wide pulse pressure. Peripheral pulses strong and bounding (“water-hammer” pulse). Head bobbing.
What are the three causes of aortic regurgitation?
Aortic root dilation (syphilis, Marfan syndrome). Bicuspid aortic valve (mostly aortic stenosis but can cause regurgitation). Rheumatic fever.
What are clinical clues for mitral stenosis?
Best heard at the apex of the heart. Best when patient is left lateral decubitus position. Enhance by expiration.
What four heart sounds are heard best when patient is left lateral decubitus position?
Mitral stenosis. Mitral regurgitation. Left-sided S3. Left-sided S4.
