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First aid Chs Part 1 > Cardiac murmurs > Flashcards

Cardiac murmurs Flashcards

1
Q

Name five systolic murmurs.

A

Aortic stenosis, Miral regurgitation, ventricular septal defect, mitral valve prolapse, HOCM

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2
Q

Name the two main diastolic murmurs.

A

Aortic regurgitation, Mitral stenosis

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3
Q

Explain the algorithm for deciphering aortic valvular murmurs on an aortic/LV pressure tracing.

A

If LV pressure is increased above 120 mm Hg, it has to be an aortic valve problem (stenosis or insufficiency). If a pressure gradient exists between the LV and aortic pressures (i.e. the aortic pressure is much lower than the increased LV pressure), it is AORTIC STENOSIS. If aortic pressure is raised with LV pressure and no gradient exists, it is AORTIC INSUFFICIENCY.

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4
Q

<p>Explain the algorithm for deciphering mitral valvular murmurs on an atrial pressure tracing.</p>

A

<p>LV pressure will be NORMAL.
Will see an increase in left atrial pressure for both mitral stenosis and regurgitation.
If increase in LA pressure occurs during diastole, it is MITRAL STENOSIS.
If increase in LA pressure occurs during systole, it is MITRAL REGURGITATION.</p>

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5
Q

What happens to EDV in mitral stenosis?

A

Decreases due to decreased ventricular filling.

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6
Q

What happens to EDV in mitral regurgitation?

A

Increases, because the elevated pressure within the left atrium is eventually transmitted to the left ventricle during filling.

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7
Q

Which murmur commonly radiates to the axilla?

A

Mitral regurgitation

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8
Q

Which murmur commonly radiates to the right sternal border?

A

Tricuspid regurgitation

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9
Q

Where does the murmur of mitral regurgitation commonly radiate?

A

Axilla

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10
Q

What will inspiration do to a tricuspid regurgitation murmur?

A

Increase

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11
Q

Mitral regurtitation murmurs are typically of what quality (audibly)?

A

Holosystolic, high pitched, “blowing”

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12
Q

Tricuspid regurtitation murmurs are typically of what quality (audibly)?

A

Holosystolic, high pitched, “blowing”

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13
Q

Describe the murmur of VSD

A

Holosystolic, HARSH sounding murmur. Loudest at tricuspid area, accentuated with handgrip maneuver due to increased afterload.

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14
Q

Inspiration will have what effect on heart murmurs?

A

Increase all right sided murmurs (except pulmonary ejection click)

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15
Q

Expiration will have what effect on heart murmurs?

A

Increase all left sided murmurs

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16
Q

What does prolonged hand grip do to hemodynamics?

A

Increases systemic vascular resistance

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17
Q

What is physiologic splitting of S2?

A

S2 splits on inspiration.

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18
Q

What causes physiologic splitting of S2?

A

Inspiration causes a drop in intrathoracic pressure, increasing venous return to RV, causing increased RV stroke volume, causing the pulmonic valve to close after the aortic.

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19
Q

What causes fixed splitting of S2?

A

ASD (due to high RA and RV volumes secondary to a R–>L shunt)

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20
Q

What is paradoxical splitting of S2?

A

Splitting of S2 on expiration

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21
Q

What causes paradoxical splitting of S2?

A

Left bundle branch block, aortic stenosis. These result in delayed or prolonged LV emptying, resulting in aortic valve closure after the pulmonary valve.

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22
Q

What does a Valsalva maneuver do to hemodynamics?

A

Decreases venous return to the right side of the heart, decreasing preload.

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23
Q

What is the auscultatory hallmark of an ASD?

A

Fixed splitting of S2

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24
Q

What causes S3?

A

Volume overload during early rapid ventricular filling

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25
Q

When is an S3 heard in the cardiac cycle?

A

Right after S2, in early diastole

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26
Q

What causes S4?

A

Atrium contracting against a stiffened ventricle

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27
Q

When is an S4 heard in the cardiac cycle?

A

Right before S1, in late diastole

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28
Q

What does inspiration do to hemodynamics?

A

Increases venous return to the right side of the heart, increasing volume/flow.

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29
Q

What effect does squatting have on hymodynamics?

A

Increases venous return, preload, and afterload

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30
Q

What effect does going from standing to squatting have on hemodynamics?

A

Increases venous return, preload, and afterload

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31
Q

What does amyl nitrate do to hemodynamics?

A

Decreases TPR (vasodilation)

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32
Q

What effect do vasopressors have on hemodynamics?

A

Increase TPR (vasoconstriction)

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33
Q

At what grade of murmur is a thrill first palpable?

A

4

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34
Q

What is a pansystolic (holosystolic) murmur?

A

A systolic murmur that has an intensity that does not change.

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35
Q

What are the only three holosystolic (pansystolic) murmurs?

A

MR, TR, VSD

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36
Q

Which murmur has a midsystolic click?

A

MVP

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37
Q

What happens to the murmur of mitral regurgitation during inspiration?

A

Nothing

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38
Q

What happens to the murmur of mitral regurgitation during isometric hand grip?

A

Increases (increased TPR “pushes” more blood back, increasing murmur)

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39
Q

What happens to the murmur of mitral regurgitation during squatting?

A

Increases (increased TPR “pushes” more blood back, increasing murmur)

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40
Q

What happens to the murmur of mitral regurgitation with administration of vasopressors?

A

Increases (increased TPR “pushes” more blood back, increasing murmur)

41
Q

What happens to the murmur of mitral regurgitation with expiration?

A

Increases (all left sided murmurs increase with expiration)

42
Q

Describe the murmur of MVP.

A

Midsystolic click with a late systolic crescendo murmur

43
Q

What happens to the murmur of MVP with squatting?

A

Midsystolic click is later in systole and murmur is shorter and less intense (due to increased venous return causing increased preload)

44
Q

What happens to the murmur of MVP with a Valsalva maneuver?

A

Makes midsystolic click earlier and lengthens murmur

45
Q

What happens to the murmur of MVP with isometric hand grip?

A

Midsystolic click is earlier in systole and murmur is longer and more intense (increased TPR “pushes” more blood back and intensifies murmur)

46
Q

What is Carvallo’s sign?

A

Tricuspid regurgitation murmur becoming louder during inspiration

47
Q

What happens to the murmur of VSD during inspiration?

A

Nothing

48
Q

What happens to the murmur of VSD with isometric hand grip?

A

Gets louder (increased TPR “pushes” more blood back and intensifies murmur)

49
Q

What 3 murmurs are described as crescendo-decrescendo?

A

AS, PS, HOCM

50
Q

What can be done to make a MR murmur worse?

A

Isometric handgrip, vasopressors, squatting (increase TPR), Expiration (increase left side return)

51
Q

What can be done to make a MVP murmur worse?

A

Valsalva maneuver, standing (decrease venous return)

52
Q

What position can you put the patient in to accentuate MS?

A

Left lateral decubitus

53
Q

What murmur commonly radiates to the carotid arteries?

A

AS

54
Q

Where does the murmur of AS commonly radiate?

A

Carotids

55
Q

Describe an aortic stenosis murmur.

A

Systolic, crescendo-decrescendo murmur with an ejection click

56
Q

What is pulsus parvus et tardus, and with what is it commonly seen?

A

Carotid pulse is weak with a delayed peak. Seen with aortic stenosis.

57
Q

What are the three classic symptoms of aortic stenosis?

A

Syncope, angina, dyspnea (SAD)

58
Q

What are the two most common etiologies of aortic stenosis?

A

Senile calcification of the valve, Bicuspid valve

59
Q

What will happen to LV and aortic pressure (with respect to each other) on a pressure curve in a patient with aortic stenosis?

A

LV pressure will increase to a much greater extent than aortic pressure, creating a PRESSURE GRADIENT.

60
Q

What is the #1 cause of mitral stenosis?

A

Rheumatic heart disease

61
Q

Describe the murmur of HOCM.

A

Crescendo-decrescendo murmur resulting from ventricular septal hypertrophy

62
Q

What will Valsalva maneuver do to the murmur of HOCM?

A

Make it louder

63
Q

What will standing (from squatting) maneuver do to the murmur of HOCM?

A

Make it louder (decreased TPR)

64
Q

What two murmurs are worsened by a Valsalva maneuver?

A

HOCM and MVP

65
Q

What will amyl nitrite do to the murmur of HOCM?

A

Make it louder (decreased TPR allows more blood to be ejected through stenotic area)

66
Q

What will isometric handgrip do to the murmur of HOCM?

A

Make it softer (increased TPR = less blood going through the stenotic “valve”)

67
Q

What will squatting do to the murmur of HOCM?

A

Make it softer (increased TPR = less blood going through the stenotic “valve”)

68
Q

What three things make the murmur of HOCM louder?

A

Valsalva, standing (from squatting), and amyl nitrate. Standing from squatting and amyl nitrate decrease TPR, allowing more blood to be forced through the stenotic area. Valsalva is kind of an oddball.

69
Q

What two things make the murmur of HOCM softer?

A

Squatting and isometric handgrip (both increase TPR, thus reducing the amount of blood that is going through the stenotic “valve”)

70
Q

What will amyl nitrite inhalation do to the murmur of AS?

A

Make it louder (decreased TPR = more blood able to go through stenotic valve)

71
Q

What will isometric handgrip do to the murmur of aortic stenosis?

A

Make it softer (increased TPR = less blood able to go through stenotic valve)

72
Q

What does inspiration do to the murmur of pulmonic stenosis?

A

Increases it

73
Q

Describe the murmur of aortic regurgitation.

A

High pitched, early diastolic decrescendo “blowing” murmur.

74
Q

Patient leaning forward during deep exhalation will accentuate with murmur?

A

Aortic regurgitation

75
Q

What is an Austin-Flint murmur?

A

A rumbling murmur caused by aortic regurgitation where the regurgitant jet of blood closes the mitral valve, causing a functional mitral stenosis.

76
Q

What is Duroziez sign and what is it associated with?

A

A systolic murmur over the femoral artery when the stethoscope is compressed proximally and a diastolic murmur over the femoral artery when it is compressed distally. Caused by aortic regurgitation.

77
Q

What murmur causes a wide pulse pressure (difference between systolic and diastolic)?

A

Aortic regurgitation

78
Q

What is Quincke’s pulse and what is it associated with?

A

Oscillation of blanching of nail beds after compression. Seen with aortic regurgitation.

79
Q

What is a Corrigan pulse and what murmur causes it?

A

Palpable abrupt upstroke and rapid fall of arterial pulsation, caused by aortic regurgitation.

80
Q

What is Traube sign and what murmur causes it?

A

Pistol shot sound over femoral artery, causd by aortic regurgitation.

81
Q

What is Mueller sign and what murmur causes it?

A

Pulsating uvula caused by aortic regurgitation.

82
Q

What is de Musset’s sign and what murmur causes it?

A

Head bobbing with each systole caused by aortic regurgitation.

83
Q

What happens to the murmur of aortic regurgitation with administration of amyl nitrate?

A

Decreases (decreased TPR = not as much blood regurgitating backwards)

84
Q

What happens to the murmur of aortic regurgitation during isometric hand grip?

A

Increases (increased TPR = more blood regurgitating backwards)

85
Q

Patient’s head is bobbing with every heartbeat. What is this called and what murmur is it associated with?

A

de Musset’s sign, associated with aortic regurgitation.

86
Q

What happens to the murmur of pulmonary stenosis with inspiration?

A

Gets louder

87
Q

What murmur has an opening snap?

A

Mitral stenosis

88
Q

Describe the murmur of mitral stenosis.

A

Delayed rumbling late diastolic murmur following an opening snap

89
Q

What is indicative of worsening mitral stenosis?

A

Opening snap occurring CLOSER TO S2

90
Q

A patient with MS has an opening snap that occurs closer to S2 than it used to. Explain.

A

The murmur is WORSENING

91
Q

What happens to the murmur of tricuspid stenosis with inspiration?

A

Gets louder

92
Q

Describe the murmur of PDA.

A

Continuous, MACHINE-LIKE murmur

93
Q

What murmur is described as continuous and machine-like?

A

PDA

94
Q

What is Beck’s triad?

A

Hypotension, JVD, and distant heart sounds (seen with pericardial tamponade)

95
Q

A >10 mm Hg decline in systolic pressure during inspiration is called what? What is it associated with?

A

Exaggerated pulsus paradoxus, associated with pericardial tamponade (but not specific for it)

96
Q

What is Kussmaul’s sign?

A

Increase in JVP during inspiration (normally, JVP decreases). Caused by constrictive pericarditis.

97
Q

What are the symptoms of mitral stenosis?

A

Dyspnea (classic), right heart failure, hoarseness.

98
Q

What two genetic disorders should you think about in a patient with MVP?

A

Ehlers-Danlos and Marfan syndromes

99
Q

Aortic dilation can cause which murmur?

A

Mitral regurgitation (dilation pulls the valve open). Think syphilis!

First aid Chs Part 1 (8 decks)

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