Cardio - Physio (Heart Auscultation & Murmurs) Flashcards
Pg. 272-273 in First Aid 2014 Sections include: -Auscultation of the heart -Heart murmurs
What are the 4 major areas for auscultating the heart? Where is each located?
(1) Aortic - right 2nd intercostal space (medial) (2) Pulmonic - left 2nd intercostal space (medial) (3) Tricuspid - left 5th intercostal space (medial) (4) Mitral - left 5th intercostal space (lateral); Think: “APT M”
For what category of heart sounds do you listen at the Aortic area? Give 3 examples.
AORTIC AREA: Systolic murmur (1) Aortic stenosis (2) Flow murmur (3) Aortic valve sclerosis
What are 2 categories of sounds that you would listen for at the left sternal border? Give at least one example of each category.
LEFT STERNAL BORDER: Diastolic murmur - (1) Aortic regurgitation (2) Pulmonic regurgitation; Systolic murmur (1) Hypertrophic cardiomyopathy
For what category of heart sounds do you listen at the Pulmonic area? Give 2 examples.
PULMONIC AREA: Systolic ejection murmur (1) Pulmonic stenosis (2) Flow murmur (e.g., physiologic murmur)
For what 2 categories of heart sounds do you listen at the Tricuspid area? Give 2 examples of each category.
TRICUSPID AREA: Pansystolic murmur (1) Tricuspid regurgitation (2) Ventricular septal defect; Diastolic murmur (1) Tricuspid stenosis (2) Atrial septal defect
For what 2 categories of heart sounds do you listen at the Mitral area? Give an example of each category.
MITRAL AREA: Systolic murmur (1) Mitral regurgitation; Diastolic murmur (1) Mitral stenosis
Explain the common early presentation of ASD and the progression of sound later in its course.
ASD commonly presents with a pulmonary flow murmur (increased flow through pulmonary valve) and a diastolic rumble (decreased flow across tricuspid); blood flow across the actual ASD does not cause a murmur because there is no significant pressure gradient. The murmur later progresses to a louder diastolic murmur of pulmonic regurgitation from dilatation of the pulmonary artery.
What effect does inspiration have as a beside maneuver used during heart auscultation?
Increase intensity of right heart sounds
What 3 effects does hand grip have as a beside maneuver used during heart auscultation, and why?
(1) Increase intensity of MR, AR, VSD murmurs (2) Decrease intensity of AS, hypertrophic cardiomyopathy/murmurs (3) MVP: increase murmur intensity, later onset of click/murmur; Hand grip (increase systemic vascular resistance)
What 3 effects does Valsava have as a beside maneuver used during heart auscultation, and why? What other maneuver has these effects, and why?
(1) Decrease intensity of most murmurs (including AS) (2) Increase intensity of hypertrophic cardiomyopathy murmur (3) MVP: decrease murmur intensity, earlier onset of click/murmur; Valsava (phase II - reduced venous return and compensation), standing (decreased venous return)
What 3 effects does Rapid squatting have as a beside maneuver used during heart auscultation, and why?
(1) Decrease intensity of hypertrophic cardiomyopathy murmur (2) Increase intensity of AS murmur (3) MVP: Increase murmur intensity, later onset of click/murmur; Rapid squatting (increase venous return, increase preload, increase afterload with prolonged squatting)
What are 3 examples of systolic heart sounds?
Systolic heart sounds include (1) aortic/pulmonic stenosis, (2) mitral/tricuspid regurgitation, (3) ventricular septal defect
What are 2 examples of diastolic heart sounds?
Diastolic heart sounds include (1) aortic/pulmonic regurgitation (2) mitral/tricuspid stenosis
What characterizes the sound of mitral/tricuspid regurgitation (MR/TR)?
Holosystolic, high-pitched “blowing murmur”
Where are the sounds of mitral and tricuspid regurgitation heard loudest, and to where do they radiate?
MITRAL - loudest at apex and radiates toward axilla; TRICUSPID - loudest at tricuspid area and radiates toward sternal border
What enhances the sound mitral versus tricuspid regurgitation?
MITRAL - Enhanced by maneuvers that increase TPR (e.g., squatting, hand grip); TRICUSPID - Enhanced by maneuvers that increase RA return (e.g. inspiration)
What are 3 common causes of mitral regurgitation? What commonly causes tricuspid regurgitation? What are 2 conditions that cause either MR or TR?
MR if often due to ischemic heart disease, MVP, or LV dilation; TR commonly caused by RV dilation; Rheumatic fever and infective endocarditis can cause either MR or TR
What characterizes the sound of aortic stenosis (AS)?
Crescendo-decrescendo systolic ejection murmur.
Compare the aortic and LV pressures during systole given an aortic stenosis.
LV»_space; aortic pressure during systole
Where is the sound of aortic stenosis (AS) heard loudest, and to where does it radiate?
Loudest at heart base; radiates to carotids
What is the effect that aortic stenosis (AS) has on pulses? What is this called?
“Pulsus parvus et tardus” - pulses are weak and a delayed peak
What are 3 symptoms that can result from aortic stenosis?
Can lead to Syncope, Angina, and Dyspnea on exertion. Think: “SAD”
What are 2 common causes of aortic stenosis?
Often due to age-related calcific aortic stenosis or bicuspid aortic valve
What characterizes the sound of VSD?
Holosystolic, harsh-sounding murmur
Where is VSD heard loudest? What maneuver can be done to accentuate the sound, and why?
Loudest at tricuspid area, accentuated with hand grip maneuver due to increased afterload
What characterizes the sound of mitral valve prolapse (MVP)?
Late systolic crescendo murmur with midsystolic click (MC; due to sudden testing of chordae tendinae).
What causes the midsystolic click in MVP?
Late systolic crescendo murmur with midsystolic click (MC; due to sudden testing of chordae tendinae).
What is the most frequent valvular lesion?
Mitral valve prolapse (MVP)
Where is MVP best heard? When is it loudest?
Beast heard over apex; Loudest just before S2
Is MVP usually benign or malignant?
Usually benign
To what condition can MVP predispose patients?
Can predispose to infective endocarditis
What 3 conditions can cause MVP?
Can be caused by myxomatous degeneration, rheumatic fever, or chordae rupture
What maneuvers cause MVP sound to occur earlier? Give 2 examples.
Occurs earlier with maneuvers that decrease venous return (e.g., standing or Valsalva)
What characterizes the sound of Aortic regurgitation (AR)?
High-pitched “blowing” early diastolic decrescendo murmur
What results from chronic AR? What are 2 symptoms with which this can pressure?
Wide pulse pressure when chronic; can present with bounding pulses and head bobbing
What are 4 causes of AR?
Often due to aortic root dilation, bicuspid aortic valve, endocarditis, or rheumatic fever.
What maneuver is used to increase AR murmur? What substances decrease intensity of AR murmur?
Increase murmur during hand grip; Vasodilators decrease intensity of murmur
What occurrence precedes mitral stenosis (MS), and why?
MS follows opening snap (OS; due to abrupt halt in leaflet motion in diastole, after rapid opening due to fusion at leaflet tips)
What characterizes the sound of MS?
Delayed rumbling late diastolic murmur
What correlates with increased severity of MS?
Decreased interval between S2 and O2 correlates with increased severity
Compare the LA and LV pressures during diastole in the context of MS.
LA»_space; LV pressure during diastole.
To what condition does MS often occur secondary?
Often occurs secondary to rheumatic fever
In what can chronic MS result?
Chronic MS can result in LA dilation
What kind of maneuvers enhance the sound of MS? Give an example.
Enhanced by maneuvers that increase LA return (e.g., expiration)
What characterizes the sound of PDA?
Continuous machine-like murmur
At what point is PDA loudest? Where is PDA best heard?
Loudest at S2; Best heard at left infraclavicular area
What are 2 common causes of PDA?
Often due to congenital rubella or prematurity
Name 4 systolic heart murmurs.
(1) Mitral/tricuspid regurgitation (MR/TR) (2) Aortic stenosis (AS) (3) VSD (4) Mitral valve prolapse (MVP)
Name 2 diastolic heart murmurs.
(1) Aortic regurgitation (AR) (2) Mitral stenosis (MS)
Name a continuous heart murmur.
PDA
