cardiac murmurs and auscultation & Tumors Flashcards
s1
- closure of the MV and TV, main sounds
occurs at the beginning of systole during ventricular contraction
s2
closure of AV and PV
occurs at the beginning of diastole during ventricular relaxation
creates the DUB sound
s3
ventricular gallop
may signal cardiac issues like CHF
s4
atrial gallop
types of mid systolic murmurs
AS
PS
HOCM
ASD
aortic stenosis
harsh and high pitched loud to soft noise
decreased EF can underestimate the degree of stenosis
location of auscultation for AS
right upper sternal border
carotids
when does mild AS peak
early systole
when does severe AS peak
later in systole
pulmonic stenosis
high pitched loud to soft noise
similar to AS
location of auscultation for PS
pulmonic listening post
radiates towards neck
HOCM
high pitched loud to soft noise
does not radiate to carotids
holosystolic murmurs
MR TR VSD
MR auscultation
apex
high pitched blowing sound
TR auscultation
left sternal border
high pitched blowing sound
VSD flows from
higher pressure LV to lower pressure RV
the smaller the louder the murmur
late systolic murmur mitral valve prolapse
listen for at apex
high pitched
mid systolic click
early diastolic murmurs
AI
PI
AI
listen for at 3rd intercostal space
soft and high pitched
Austin flint murmur
severe AI low pitched
mid to late diastole
PI
listen for at 3rd or 4th intercostal space
soft and lowpitched
graham steele murmur
mid to late diastolic murmurs
MS and TS
what does MS sound like
opening snap from high left atrial pressures
low pitched diastole rumble
listen for at apex
listen for TS
lower left sternal border
similar to MS
PDA : patent ductus arteriosus
continuous murmur
begins at S1 and peaks at S2
pulsus alternans
a strong pulses followed by a weaker pulse
progressive systolic heart failure
a flag that the heart is trying to sustain itself in systole
pulsus bigeminus
hoofbeats within each heartbeat
heartbeats occurs closely to each other followed by a long pause
pulsus bisferiens
seen with aortic valve disease
2 pulses to each heartbeat
pulsus tardus
stiff aortic valve
av harder to open causing increase in lv pressure
pulsus paradoxus
where some heartbeats cannot be detected at the radial artery during inspiration
caused by an exaggerated decrease In BP
JVP is used to assess what
central venous pressure
high JVP = high CVP
multiphasic JVP
JVP beats twice in the cardiac cycle
paradoxical JVP
jvp rises with inspiration drops with expiration called kussmauls sign
seen with pericardial eff. tamponade and pericarditis
JVP can help differentiate between …
heart and lung disease
myxoma
intracardiac tumors
most common benign tumors in adults, in females
made up of mucous cells
USUALLY in LA
sono of myxoma
heterogenous with sharp demarcated borders
mottled appearance
mimics valvular stenosis
symptoms of myxoma
diastolic murmur
syncope
chest pain
may have stroke due to embolize
lipoma
benign
dumbbell shape over fossa ovals
mature fat cells
location: LV RA IAS
fibroma
2nd most common pediatric tumor
location usually LV or RV
fibroma sono
intramural and solitary
usually large
S & S of fibroma
left axis deviation
CHF
LVOT obstruction
ventricular arrhythmias
rhabdomyoma
most common tumor in children
associated with Pringles disease
rhabdomyoma usual location
usually in LV or RV
s & s of rhabdomyoma
majority asymptomatic
av block
pericardial effusion
arrhythmias
teratoma
rare in children
usually in RA
papillary fibroelastoma
second most common tumor
most common valvular tumor
usual location of papillary fibroelastoma
on MV or AV in adults
TV in children
soon appearance of papillary fibroelastoma
move independently
could be on chordae
s & s of papillary fibroelastoma
asymptomatic unless large and can embolize
malignant sarcoma
affects men more than women
in RA
rare
angiosarcoma
most common type of sarcoma
usually in RA or pericardium
sono angiosarcoma
RVIT or RVOT pericardial effusion
fibrosarcoma causes
causes HF and arrhythmia infiltrates myocardium (anterioseptall wall)
rhabdosarcoma
can be in any chamber
25% in younger patients
2nd most common malignancy
metastatic tumors
40 times more common
where do most metastatic tumors come from
lung, breast, renal carcinoma, or melanoma
soon appearance of metastatic tumors
pericardial effusion most common finding that contains strands
profusion of mass into the chambers via IVC or pulmonary veins
s & s of metastatic tumors
tamponade
heart failure
arrhythmia
how can malignancies travel to the heart
- lymphatic system
- pulmonary veins
- pericardium to myocardium to endocardium
- via IVC to right heart
apical thrombus
- in areas of Akinses or dyskinesis
- associated with anterior myocardial infarction
types of apical thrombus
layered
single
multilobulated
pedunculated
how to asses for apical thrombus
- interrogated the apex with high freq. transducer
- color flow doppler
- alter depth
- change views
- contrast echo
- TEE
left atrial thrombus
can develop in patients with A fib
normal variant: lambls excrescences
connective tissue with elastic bands, very thin strand on AV
