Clinical Flashcards
ID this Pathologic heart condition
Medium pitch, harsh, crescendo-decrescendo, mid-systolic, over R 2nd ICS
Radiates to both carotids
Aortic Stenosis
D this Pathologic heart condition
Quiet, medium-high pitch, blowing, early diastolic, decrescendo, over L 3-4th ICS (radiated sound)
May radiate to apex
Heard better with forward leaning
Aortic Insufficiency/Regurtitation
This is the only murmur that you will hear better away from where the problem is.
Where is the PMI located, and how might you explain a lateral deviation from this point?
The point of maximal impulse is normally at the apex of the heart and taps the chest wall near the 5th intercostal space. If the heart is enlarged though it can be palpated more laterally.
What is Jugular Venous Distension (JVD) indicative of ?
Increased R sided pressure or heart failure
Why would you use the bell instead of the diaphragm of the stethascope?
Bell can detect low pitch sounds and is good for listening to the AV valves or over vessels.
The diaphragm is what you normally use to listen to valves, sometimes you want to hear a murmur more clearly so you choose the bell.
Why do sports physicals include a squating or valsalva maneuver?
This will alter venous return and intracardiac blood volume and may accentuate a murmur that could lead to sudden death; like a hypertrophic obstructive cardiomyopathy (HOCM)
Your patient has a cardiac bruits, what should you use to listen to it?
Bell
Your attending in front of a group of students tells you to listen to a paradoxical S2 split. Where should you place your stethascope? To hear the murmur better what should you instruct you patient to do?
Erbs point in the 3 intercostal space
exhale (normally inhalation would accentuate a physiologic split S2)
What are some trends you see in murmur sounds?
Regurgitation is holosystolic
Stenosis sounds like rumbling
What is HOCM?
hypertrophic obstructive cardiomyopathy
To remember more:
H-harsh sounding murmur
O- thickened ventricular septum (O is the left ventricle in this example)
C-decreased CO
M-midsystolic murmur and medium pitch sound
Also HOMeComing is when your athletes die! Can cause sudden death.
Your ascultating a patients anterior lungs and you notice a continuous systolic and diastolic sound that is mechanical in nature over the L upper chest near the MCL. What’s the most likely congenital heart defect?
Patent Ductus Arteriosus
PDA
Snaps and clicks in the heart are from what? Rubs?
Opening snaps-AV valves during diastole; stenosis
Ejection clicks (ejecting a cartridge out of a gun)- max opening of semi-lunar valves.
Rubs- Pericardial Friction Rub: Increased fluid (train sound); with heart beat
Pleural rub-purr, slower, with inhalation
