Cardiac Mummurs/Pathophys Flashcards
What murmur is hear in mitral stenosis?
OS followed by mid-late-DISASTOLIC rumbling
Systolic murmurs: (4)
- Aortic/Pulmonic Stenosis
- Mitral/Tricuspid Regurgitation
- Mitral Valve Prolapse
- Ventricular Septal Defect
Diastolic murmurs: (2)
- Aortic/Pulmonic Regurgitation
2. Mitral/Tricuspid Stenosis
What type of murmur is a mitral valve prolapse?
Systolic
What is the murmur head with mitral prolapse?
systolic murmur with mid-systolic click; d/t excess valvular tissue prolapsing from Left atrium.
Clinical signs commonly associated with aortic regurgitation: (3)
- Head bobbing
- Pulsating nail bed (d/t widened pulse pressure)
- Water hammer pulse (d/t widened pulse pressure)
______ regurgitation is an early, high pitched “blowing” diastolic murmur.
Aortic regurgitation
3 causes of aortic stenosis?
- cong. bicuspid aortic valve (pt. <30 years)
- degenerative age-related calcified aortic valve (pt. >60)
- chronic rheumatic fever
In a sexually active Pt. a high pitched, blowing diastolic murmur suggests what valvular issue?
aortic regurg; ==> soft, tumor-like growths concerning for gummas in tertiary phase of syphillis.
_______ regurgitation: holosystolic high pitched “blowing” murmur, heard loudest at the apex, radiates to the axilla.
Mitral regurg.
what murmur presents as a holosystolic high pitched “blowing” murmur, heard loudest at the apex, radiates to the axilla.
Mitral regurgitation
what cardiac valvular issue can lead to left-atrial dilation and hypertrophy which compresses the esophagus and lead to dysphagia for solids?
Mitral stenosis
What cardiac valvular issue leads to increase in systolic pressure leads to an increased pulse pressure?
Aortic Regurgitation. ejected blood from the aorta back to the L.V. during diastole. this decrease peripheral arterial diastolic pressure leading to a increase LVEDV, which increases SV.
“Pulsus parvus et tardus”: pulses are weak and late compared to heart beat due to outflow obstruction secondary to a stenotic _____ valve
aortic valve
A prior MI is concerning for (what murmur?) with papillary muscle dysfunction
mitral regurgitation
Exertional dyspnea, angina, syncope, and a congenital bicuspid valve usually point to what valvular issue?
aortic stenosis
Tertiary syphilis is associated with (what murmur?) Patients may also present with “gummas,” or, soft tumors on his or her hands and elbows.
aortic regurgitation
What murmur is almost always secondary due to rheumatic heart disease?
Mitral stenosis; typically presents with signs of pulmonary congestion, rather than angina.
what murmur typically presents with signs of pulmonary congestion, rather than angina?
Mitral stenosis
Mitral valve prolapse associated with genetic disorders (5)
- Marfan’s syndrome
- Ehlers-Danlos syndrome
- ADPKD
- Fragile X syndrome
- Klinefelter syndrome
That is the classic triad S/Sx of aortic stenosis?
- Syncope (decreased blood flow to brain).
- Angina (decreased blood flow through coronary arteries in diastole).
- Dyspnea.
Pt. with the following S/SX ==> ?
- Osler nodes (tender subcutaneous lesions on finger or toe pads)
- Splinter hemorrhages
- Janeway lesions (painless erythematous lesions on palms or soles)
endocarditis; Multiple positive blood cultures are required to diagnose bacterial endocarditis.
____________ is a systolic murmur with mid systolic click due to excess valvular tissue prolapsing into the left atrium
Mitral prolapse
Papillary muscle damage post MI causes what murmur?
mitral regurgitation
Mitral valve prolapse/hypertrophic cardiomyopathy causes what murmur?
mitral regurgitation
LV dilation with stretching of mitral valve ring causes what murmur?
mitral regurgitation
Rheumatic heart disease causes what murmur?
mitral regurgitation
Infective endocarditis with valvular damage causes what murmur?
mitral regurgitation
Tuberous sclerosis causes what murmur?
mitral regurgitation
What is the outcome of chronic mitral regurgitation?
the left atrium compensates to the increased volume by dilating and increasing compliance which leads to increased incidence of fibrillation rhythms.
What murmur results in increased left atrium pressures and pulmonary congestion?
Acute mitral regurgitation
what murmur is characterized by a holosystolic high pitched “blowing” murmur, heard loudest at the apex, radiates to the axilla.
mitral regurgitation
Mitral regurgitation sounds like?
holosystolic high pitched “blowing” murmur, heard loudest at the apex, radiates to the axilla.
What murmur can result in left atrial dilation and hypertrophy?
Mitral Stenosis; this can result in atrial fibrillation, which is associated with stasis and thrombus formation leading to possible embolization.
What murmur is heard as an opening snap followed by mid- to late-diastolic rumbling?
Mitral stenosis
What murmur is associated with a crescendo-decrescendo systolic ejection murmur radiating to the carotids.
Aortic stenosis
What murmur radiating to the carotids?
Aortic stenosis
What murmurs can hear in the aortic area?
- aortic stenosis
- flow murmurs (normal/physiologic murmurs)
- aortic valve sclerosis
The following murmurs can be heard where on the chest?
- aortic stenosis
- flow murmurs (normal/physiologic murmurs)
- aortic valve sclerosis
aortic area
What murmurs can you hear at the left sternal border?
diastolic: aortic and pulmonic regurg.
systolic: HCM
What murmurs can you hear at the pulmonic area?
systolic ejection murmurs: pulmonic stenosis, flow murmurs.
What murmurs can you hear at the tricuspid area?
holosystolic: tricuspid regurg, VSD
diastolic: tricuspid stenosis, ASD d/t increase flow across the tricuspid vavle.
What murmurs can you hear at the mitral area?
holosystolic murmur: mitral regurg.
diastolic murmur: mitral stenosis
mitral valve prolapse
What does inspiration do?
increase venous return to right atrium ==> increase intensity of RIGHT heart sounds.
What does hand grip do?
increase afterload. increases intensity of MR, AR, and VSD.
decreases HCM.
How does Valsalva effect murmurs?
DECREASE PRELOAD!!!
decreases the intensity of most murmmursl INCREASES HCM!
later onset of click/murmur in MVP.
How does standing up from sitting effect murmurs?
DECREASE PRELOAD!!!
decreases the intensity of most murmmursl INCREASES HCM!
later onset of click/murmur in MVP.
What does rapid squatting do to murmurs?
increases: preload, afterload, and venous return.
DECREASES HCM.
increases intensity of aortic stenosis.
What bedside maneuver increases intensity of aortic stenosis?
rapid squatting
What bedside maneuver decreases the murmur ~w/ HCM?
rapid squatting
What bedside maneuver INCREASES the murmur ~w/ HCM?
Valsalva or standing up from sitting; decreases preload.
continuous machine-like murmur, loudest at S2 ==>
PDA
