Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Summative Review > Cardio: murmurs > Flashcards

Cardio: murmurs Flashcards

1
Q

S3 gallop

A

dilated cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

harsh systolic murmur best heard at LSB

A

hypertrophic cardiomyopathy HOCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

hypertrophic cardiomyopathy (HOCM)

A

harsh systolic murmur best heard at LSB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dilated cardiomyopathy

A

S3 gallop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

similarities with aortic stenosis + HOCM

-differences?

A
  • angina
  • systolic murmur
  • both murmurs go in the same direction with afterload maneuvers– both increase with Amyl nitrate and both decrease with handgrip

DIFFERENCES

  • HOCM
  • preload maneurvers that decrese LV volume (valsava, standing) will WORSEN the murmur—->these manuecers decrease intensity of aortic stenosis murmur
  • increased volume (squatting, leg raise) will decrease the murmur of HOCM—-vs will increase intensity of AS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

sitting up and leaning forward

A

accentuates Aortic murmurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

lying on the left side

A

accentuates mitral murmurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

increased venous return

A

inreases ALL murmurs/opening snap (left and right side)

EX of incr venous return=squatting, leg raise, lying down,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

decreased venous return

A

*valsalva
*standing
*decreases all murmurs/opening snap (left and right)
EXCEPT: increase murmurs of HOCM and increased ejection click of MVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Inspiration

A

increases venous return on the right side
inncreasesd all murmurs/opening snap on the RIGHT side only
decreased ejection click right side
**RIGHT SIDED MURMURS HEARD BEST WITH INSPIRATION

decreased venous return on the left side
*all murmurs/opening snap on the left side are decr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

right sided murmurs heard best wth

A

inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

expiration

A

incrs venous return on the lft side
-incrs murmurs on left side—delyes ejection click on L side

decrs venous rreturn to the right sife

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

left sided murmurs heard best?

A

after maximal expiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

handgrip

A

increased afterload by compression the arteries of the upper extremityy–>leading to decreaed LV emptying
-decreased forward flow and increased backward flow

  • **outflow murmurs (AS, HOCM, MVP) are decr with handgrip
  • incr in afterload prevents blood from being ejected from ventriles–lessening the blood flowing through stenosed aortic valvue and less blood ejected in HOCM

**regurg murmurs (AR, MR) incr with handgrip due to backward flow

*MS increased due to incr afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the only two things that affect AS and HOCM

A

handgrip (decrs) and amyl nitrate (incrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

amyl nitrate

A

decreases afterload–direct arteriolar vasodilator leading to increased LV emptying—increases flow and decreases backward flow of blood

  • AS, MVP, HOCM incrs
  • regurg murmurs (AR, MR) decr
  • **why afterload reducers like ACEI are used in tx of AR and MR
17
Q

Aortic Stenosis

  • quick patho
  • etiologies (3 basic categories)
  • CM– mc?
  • PE
  • what incrs murmur
A

PATHO

  • LV outflow obstruction leads to fixed CO, incr AL, LVH and eventual LV failure
  • etiologies:
    1. Degenerative: calcifications*****, wear/tear, over 70yO
    2. congenital and bicuspid valve common in <70
    3. rheumatic HD: isolated or accomp with AR

CM

  • Once symptomatic—lifespan dramatically reduced
  • dyspnea MC s/s
  • ***ANGINA: MC symptom—one this happens–5 year mean survival
  • *syncope=3 yr survival
  • *CHF=2 yr survival

PE

  • harsh ejection systolic crescendo-decrescendo murmur
  • best heard at RUSB
  • split S2
  • radiating to the carotid
  • weak + delayed carotid pulse– pulsus parvus et tardus
  • narow pulse pressure

INCRS:

  • sitting while leaning forward
  • incr venous return–sqautting supine, leg raise
  • expiration

DECRS:

  • decr venous return–valsalva, standing
  • inspiration
  • handgrip
18
Q

harsh systolic crescendo-decrescendo murmur heard at RUSB

A

AS

19
Q

Aortic Regurg

  • quick patho
  • etiologies
  • pe
  • cm
  • incrs
  • decrs
A

*incomplete aortic valvue closure leads to LV volume overload with eventual LV dilation and HF

ETIOLOGIES

  1. acute: AMI, aortic dissection, encoarditis—-all can lead to pulmonary edema
  2. chronic: aortic dilation–Marfan syndrome, inflamm disordres, Rheumatic fever, syphilis, HTN

PE
*high pitched diastolic blowing decrescendo murmur best heard at the LUSB

INCRS

  • sitting while leaning forward
  • incr venous return–supine ,squatting, leg raise
  • expiration
  • hand grip

DECRS

  • decr venous return–valsalva, standing,
  • inspiration
  • amyl nitrate

CM

  • austin flint murmur–>mid-late diastolic rumble at the apex secondary to retrograde regurg
  • BOUNDING PULSES–due to incr SV
  • pulses bisferiens
  • widened pulse pressure
  • water hammer pulse
20
Q

water hammer pulse

A

AR

21
Q

high pitched diastolic blowing decrescendo murmur best heard at the ULSB

A

AR

22
Q

opening snap

A

MS

23
Q

Mitral Stenosis

  • patho
  • etiologies—-MC?
  • cm
  • decrs
  • incrs
A

*obstruction of flow from LA–LV secondary to narrowed mitral oriface–>blood backs up in the LA–>incrs LA pressure/volume overload–>pulmonary congestion–>pulmonary HTN–>CHF

ETIOLOGIES

  • RHEUMATIC FEVER is almost always the cause—3 or 4 decade of lief
  • congenital, myxoma LA, thrombus, valvulities (SLE, amyloidosis, carcinoid)

CM

  • PULM
  • dyspnea (MC s/s)
  • pulm edema
  • hemoptysis
  • pulm HTN
  • AFIB
  • secondary to atrial enlargement
  • Right HF
  • Mitral Faces–>ruddy/flushed cheeks with facial pallor—chronic hypoxia

*signs of LA enlargement–dysphagia (esoph compression), Ortner’s syndrome (recurrent layngeal nerve palsy)–hoarsnensss

PE

  • prominent S1 opening snap
  • low-ptiched mid-diastolic rumbling murmur best heard at the apex

INCRS
*left lateral decubitus

DECRS
*decr venous retunr— valsalva, standing

24
Q

Diastolic low pitched decrescendo rumbling murmur with opening snap heard best at the apex

A

Mitral stenosis

25
Q

Mitral regurg

  • patho
  • etiolgies– mcc in us and devlop countries
  • cm
  • pe
A

PAHTO
*abnm retrograde flow from LV into LA– leading to leeft atrial dilation and increaed pulmonary pressure

ETIOLOGIES

  • MVP MC cause in US
  • rheumatic fever MCC in devlop countries

CM

  • chronic: HF–dyspnea MC s/s, afib, HTN, hemoptysis
  • acute: pulm edema, hypotension

PE
*blowing high pitched holosystolic murmur best heard at the apex with radiation to the axilla
INCRS: left lateral decubitus, expiration, isometric exercise, incr venous return (squatting, leg raise, lying supine), handgrip
DECRS: decr venous return–valsalva, standing, inspirtion, amyl nitrate
*widely split s2, laterally displaced PMI, S3, soft S1 for severe cases

26
Q

blowing high pitched holosystolic murmur best heard at the apex with radiation to the axilla

A

mitral regurg

27
Q

mitral valve prolapse

  • quick patho
  • mcc of?
  • mc in w or m
  • %of population

etiologies
cm
pe

A

leaflefts of MV bulge into left atrium during systole
MVP MCC of mtiral regurg in US ****
MC in young women (15-30yO)
2-5% of population

ETIOLOGIES

  • Myxomatous degeneration of mitral valvue
  • CT dz— marfans

CM

  • most asympto
  • autonomic dysfunction–>anxiety, atypical CP, panic attacks, palpitations from arrhythmias, syncope, dizzines, fatigue

PE

  • Mid-late systolic ejection click best heard at the apex.
  • EARLIER CLIKC + LONGER MURMUR DURATION: anything that makes LV smaller aka decrs preload–>valsalva, standing due to iincrs prolapse
  • DELAYED CLICK + SHORTER MURMUR DURATION: anything that makes LV bigger (incrs preload) due to decr prolapse— handgrip
28
Q

Mid-late systolic ejection click best heard at the apex

A

MVP

29
Q

Pumonic stenosis

-mc etiology

A

right ventric outflow obstruction of blood across the PV
-almost always congenital and a dz of young——

PE
*harsh mid-systolic ejection crescendo-decrescnedo murmur that radiates to the neck
*maximal at the LUSB
INCRS: inspiration

30
Q

harsh mid-systolic ejection crescendo-decrescnedo murmur that radiates to the neck

A

pulmonic stenosis

31
Q

Pulm regurg

  • etiologies
  • pahto
  • cm
  • pe
A

almost always congenital*****
others: pulm htn, tetraology of fallot, endocarditis, rheumatic HD

patho
*retrograde flow from pulmonary artery into RV–>right sided overload

CM

  • most clinically insignificant
  • sympotmatic=right sided HF

PE
*Graham Steell murmur–> brief decrescendo early diastolic murmur @ LUSB (2nd L ICS) with full inspiration
INCRS: incr venous return–sqautting supine inspiration
DECRS: dcr venous return–valsalva, standing, expiration

32
Q

brief decrescendo early diastolic murmur @ LUSB (2nd L ICS) with full inspiration

A

pulm regurg

33
Q

Tricuspid Stenosis

A

blood backs up into right atrium–>incrs right atrial anlargement–>right sided HF

PE
*mid-diastolic murmur at LLSB (xyphoid, 4th ICS)
*low frequency
INCRS: incr venous return–squatting, supine, inspiration, leg raise,
+opening snap but occurs later than the one for MS

34
Q
  • mid-diastolic murmur at LLSB (xyphoid, 4th ICS)

* low frequency

A

tricuspid stenosis

35
Q

Tricuspid Regurg

A

holosytolics blowing high pitched murmur at the subxyphoid are (left mid-sternal brorder)
-little to no radiation
-INCRS: invr venous return— squatting, supine, inspiration, leg raise
-Carvallo’s sign: incr murmur intensity with inspiration–due to incr right isded vlood flow during inspiration——helps to distinguish TS from MR
+/- pulsatile liver

36
Q

holosytolics blowing high pitched murmur at the subxyphoid are (left mid-sternal brorder)

A

tricuspid regurg

Summative Review (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions