Cardiovascular Exam - Part 2 Flashcards
Heart murmurs
Pressure gradient+restirctive orofiice = turbulent blood flow
Forward stenosis or backward leak
In systole - either mitral regurgitation or aortic stenosis
IN diastole - either aortic regurgitation or mitral stenosis
1-6 grading
1 - very faint
2 - clearly heard
3 - very loud, no thrill
4- palpable thrill
5 - heard with stethoscope barely off chest wall
6 - heard with stethoscope off the chest wall
QUality
Blowing - high pitched
Harsh - low pitched
Musical - sea gull (calcium)
Midsystolic
Holosystolic
Late systolic
Crescendo-decrescendo or diamond
Pansystolic, plateau
Crescendo
Early diastolic
Middiastolic
Late diastolic
Decrescendo
Decrescendo
Crescendo
Innocent and physiologic murmur
Turbulent blood flow across pulmonic valve without path abnormalities
Common in children and Y/A
May be resent in hyperdynamic states
Midsystolic best heard in the 2nd and 3rd LIS with minimal radiation
Usually less than grade 2 and blowing
Dec in sitting position
No other auscultatory abnormalities
Aortic stensosi
Midsystolic murmur best heard at base
Radiates to LSB, apex, and neck
Murmur increases with pt sitting and leaning forward
May have dminished S2, paradoxial splitting, signs of LV hypertrophy or dysfunction, S4 gallop, small and weak pulse
IHSS
Hypertrophied interventircular setpum
Systolic anterior motion of the anterior mitral valve leaflet
Narrowed outflow
Midsystolic
Rough or harsh
May radiated to apex or base but NOT neck
No pulsus parvus et tardus
S4 often present
Sustained apical impulse
Murmur increases with maneuvers that dec ventricluar chamber size
Murmur dec with maneuvrs that inc ventricular chamber size (squatting)
Mitral regurgitation
Holosystolic murmur best heard at apex
Radiates to axilla and less to LSB and base
S1 may be dminished
S3 may be present with increased nad prolonged apical impulse (dilated LV)
Dose NOT increase with inspiration
Tricuspid regurg
Dilayed RV
Holosystoicl heard at LSB
Murmur radiated
Murmur WILL intensify with inspiration
Right side RS may be present iwth prolonged RS apical impulse
Aortic regurg
Early, decrescendo, and blowing diastolic murmur
May radiate
Best heard during exhalation with pt sitting and leaning forward
May have S3/S4, midsystolic ejection murmur, rough diastolic murmur, large nad boudnign pulses, signs of LV hypertophy
MItral stenosis
Midlate rough diastolic murmur or rumber iwht presystolic accentuation
Best heard with bell at apex, particularly in the left lateral position, after exercise and during exhalation
Minimal radiation
Sharp S1 and opening snap
