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CPR Exam 1 > Cardiac Clinical Med 3 (Johnston) > Flashcards

Cardiac Clinical Med 3 (Johnston) Flashcards

1
Q

What causes murmurs?

A
  • Turbulence across valve and or increase blood flow (anemia, pregnancy)
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2
Q

What can cause stenosis? What is the result of stenosis?

A
  • Sclerosis, fibrosis, calcification
  • Impedes forward flow creating a pressure overload
  • Results in hypertrophy and HF
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3
Q

What is regurgitation?

A
  • Reversal of flow, valve leaks, fails to close

- Creates a volume overload and results in dilation

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4
Q

What are some disorders that are systolic murmurs?

A
  • Mitral regurgitation
  • Tricuspid regurgitation
  • Aortic stenosis
  • Pulmonic stenosis
  • VSD
  • ASD
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5
Q

What are some disorders that are diastolic murmurs?

A
  • Aortic regurgitation
  • Pulmonic regurgitation
  • Mitral stenosis
  • Tricuspid stenosis
  • Atrial myxoma
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6
Q

What is the grading scale for murmurs?

A
  1. Barely audible
  2. Faint, soft
  3. Louder, easily heard
  4. Very loud with palpable thrill
  5. Heard with stethoscope barely touching the chest with thrill
  6. Can hear without stethoscope or can hear with stethoscope close to chest with palpable thrill
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7
Q

What physical and auscultatory findings are associated with acute mitral regurgitation?

A
  • Ischemic papillary muscle dysfunction
  • Ruptured chordae tendineae
  • Infective endocarditis
  • Volume overload, inc. LA pressure, pulmonary edema, RVF/LVF cardiogenic shock
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8
Q

What physical and auscultatory findings are associated with chronic mitral regurgitation?

A
  • Mitral valve prolapse
  • Myxomatous or degeneration or mitral annular calcification
  • Will hear blowing at apex, radiates into left axilla
  • Reduced S1– use diaphragm
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9
Q

What physical and auscultatory findings are associated with mitral valve prolapse?

A
  • Asymptomatic chest pain, SVT, PVCs, dyspnea, systolic murmur at apex, may have click increase with valsalva and standing
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10
Q

What physical and auscultatory findings are associated with tricuspid regurgitation?

A
  • Significant if associated with pulmonary HTN, lung disease, RV infarction, inferior wall MI, IE, pacemaker
  • Blowing systolic murmur hear in 4th ICS LSB: increases on inspiration
  • Prominent V wave in jugular venous pulse
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11
Q

What physical and auscultatory findings are associated with aortic stenosis?

A
  • Dyspnea
  • Angina
  • Syncope
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12
Q

What does the physical exam look like with aortic stenosis?

A
  • Systolic murmur: crescendo-decrescendo
  • Harsh 2nd ICS RSB which radiates into sternal notch/carotids
  • Diminished S2
  • Narrow pulse pressure (140/100)
  • ECG- LVH, strain patter (down sloping of ST segment)
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13
Q

What physical and auscultatory findings are associated with bicuspid aortic valve?

A
  • Associated with aortic root dilation, IE/systolic murmur/click, LSB or apex
  • In Marfans or turners syndrome
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14
Q

What physical and auscultatory findings are associated with pulmonic stenosis?

A
  • Systolic murmur: crescendo-decrescendo
  • 2nd-3rd ICS LSB, radiates to left shoulder/clavicle
  • May be associated with tetralogy of fallot
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15
Q

What physical and auscultatory findings are associated with VSD?

A
  • Holosystolic murmur
  • Left lower sternal border with thrill
  • L to R shunt
  • Murmur increases with hand grip
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16
Q

What physical and auscultatory findings are associated with ASD?

A
  • L to R shunt
  • Systolic murmur
  • Upper LSB with fixed splitting of S2
17
Q

What physical and auscultatory findings are associated with mitral stenosis?

A
  • Dyspnea, orthopnea, palpitations, arrhythmias, hoarseness
  • Diastolic murmur
  • Low pitch (use bell)
  • Rumbling at apex
  • Inc. S1 and S2 followed by opening snap
18
Q

What physical and auscultatory findings are associated with tricuspid stenosis?

A
  • Diastolic murmur LSB
  • Increases on inspiration
  • Prominent A wave in jugular wave
19
Q

What pathology of aortic regurgitation?

A
  • Volume overload leading to LVH and left HF
  • Symptoms depend on rapidity of onset
  • Acute with have pulmonary edema
  • Chronic will have dyspnea, orthopnea, angina
20
Q

What physical and auscultatory findings are associated with aortic regurgitation?

A
  • Decrescendo murmur
  • 3rd ICS LSB (can mimic MS soft S2)
  • Wide pulse pressure (130/50)
  • Demusset sign
  • Quincke’s sign
  • Traube sign
  • Duroziez’s sign
21
Q

What is DeMusset sign?

A
  • Head bob with beats
22
Q

What is Quincke’s sign?

A
  • Capillary nail pulsations
23
Q

What is Traube sign?

A
  • Pistol shot sounds over femoral artery
24
Q

What is Duroziez’s sign?

A
  • Diastolic murmur over femoral artery when compressed with bell of stethoscope
25
Q

What physical and auscultatory findings are associated with pulmonary regurgitation?

A
  • Decrescendo murmur
  • 2nd ICS LSB
  • Associated with pulmonary HTN
  • Increased S2

CPR Exam 1 (21 decks)

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