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Internal Medicine > Cardiac Auscultation > Flashcards

Cardiac Auscultation Flashcards

1
Q

Even triplet best heart at apex

A

Mitral valve prolapse

Name: Mid-systolic click

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2
Q

Uneven triplet at front side (right after s1) best heard over aortic valve

A

Early systolic ejection click

Bicuspid aortic valve

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3
Q

Murmur that bicuspid aortic valve often predisposes patient to?

A

Obstructive systolic ejection murmur

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4
Q

Late systolic murmur heard best at apex

A

Mitral valve prolapse

*often one leaflet is insufficient ex. papillary muscle rupture, ruptured chordae tendinae, vegitation, trauma etc.

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5
Q

holosystolic murmur

A

Mitral or tricuspid insufficiency or

VSD

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6
Q

Early diastolic murmur

A

aortic insufficiency (acute)

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7
Q

Late systolic murmur

A

Insufficient valve, papillary muscle rupture etc.

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8
Q

Holodiastolic murmur

A

Aortic insufficiency (late)

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9
Q

Irregular rhythm
+ opening snap
+ mid-to-late diastolic murmur

A

A fib

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10
Q

Common valvular reason for a. fib

A

mitral stenosis

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11
Q

Early systolic ejection murmur and fixed split S2

A

ASD

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12
Q

S4

A

Right before S1
Caused by STIFF heart, DIASTOLIC DYSFUNCTION
Happens in elderly

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13
Q

Intermittent

A

S4

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14
Q

S3

A

Dull thud after S2
SYSTOLIC dysfunction
Ex. myocardial fibrosis, prior MI

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15
Q

Sounds like S3 but is NOT dull

A

Mitral valve OPENING SNAP
Beginning of diastole
Happens in mitral stenosis

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16
Q

Sounds like a snorting pig out of breath

A

2-Part pericardial friction rub

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17
Q

Mid diastolic rumble

Irregular

A

A fib

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18
Q

HOLO SYSTOLIC

A

Mitral insufficiency

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19
Q

HOLO DIASTOLIC

A

CHRONIC Aortic insufficiency

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20
Q

Early Diastolic murmur

A

Acute/early Aortic insufficiency

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21
Q

CXR of aortic insufficiency

A

Huge left ventricle

22
Q

Causes of paradoxical splitting of S2

A

Systemic hypertension
Aortic stenosis
LBBB

23
Q

Timing of mitral stenosis opening snap

A

Right after S2 (early diastolic)

24
Q

Likely cause of S3 on exam

A

Myocardial fibrosis from prior MI

25
Q

What will be the result of a stiff heart?

A

Won’t stretch in response to filling…Diastolic dysfunction!
You will hear an S4
*Common in elderly, S4 is an atrial kick caused by the resistance to filling

26
Q

How do you differentiate HOCM from aortic stenosis when you hear a ____________ ?

A
  • obstructive systolic ejection murmur!

You do some maneuvers!

  • Squatting DECREASES the murmur of hypertrophic cardiomyopathy.
  • Valsalva INCREASES the murmur of hypertrophic cardiomyopathy.

(the opposite of both of these is true for aortic stenosis)
AS is increased by squatting because there is more blood to the heart.
AS is decreased by valsalva because there is less blood in the hear so there is less turbulence of flow over the stenotic valve.

27
Q

fixed split s2

A

ASD

28
Q

3 things to remember for the sounds of A. Fib:

A

Irregular rhythm
Opening snap
Mid-to late diastolic murmur

(Mitral stenosis + irregular)

29
Q

What-to-dooooooo

A

Mitral stenosis!

Opening snap after S2 followed by mid to late diastolic murmur

30
Q

In general, what happens to Right sided murmurs upon inspiration

A

Increase! More blood to heart

31
Q

What should happen to neck veins with inspiration?

A

Decrease

32
Q

If neck veins increase with inspiration, what do you call this and what does it signify?

A

Kussmual sign

-Suggests cardiac tamponade or R ventricular failure

33
Q

What happens to mitral regurgitation with inspiration?

A

SOFTER

34
Q

What happens to VSD with Inspiration?

A

DOES NOT CHANGE

35
Q

What happens to Mitral valve prolapse with squatting?

A

Comes later…more toward S2

36
Q

If you stand with legs hanging down…you have decreased blood return to the heart. what does this do to MVP?

A

Occurs earlier…closer to S1

37
Q

What happens to an innocent murmur when you stand?

A

Goes away!

38
Q

How do you intensify the murmur of Aortic insufficiency?

A

ISOMETRIC hand grip! Increases systemic arterial pressure

39
Q

What happens to the obstructive systolic ejection murmurs when you have them do isometric handgrip?

A

They decrease….

i guess

40
Q

What, in general, happens to left-sided heart murmurs when you valsalva?

A

They get louder for 2 or 3 beats

41
Q

What should you look for on EKG with an ASD?

A

Right atrial hypertrophy = peaked p waves in lead II

42
Q

EKG in MVP leading to MR

A

LVH

A fib

43
Q

CXR in patient with hypertrophic cardiomyopathy

A

normal

44
Q

Three things for which you will hear holosystolic murmur

A

Mitral regurgitation
Tricuspid regurgitation
VSD

45
Q

Difference in murmur between acute vs chronic aortic insufficiency?

A

Acute: short-lived diastolic murmur
(musical, apparently)

Chronic: holodiastolic

46
Q

Aortic insufficiency murmur ____________ in response to isometric hand grip.

A

increases

47
Q

Clinical finding of aortic insufficiency

A

widened pulse pressure!

48
Q

When might we see acute aortic insufficiency?

A

aortic dissection - see mediastinal widening on CXR

49
Q

When do you see “straightening of the upper left border of the cardiac silhouette on CXR?”

A

Mitral stenosis

50
Q

CHF

A

s3

Internal Medicine (2 decks)

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