Clinical Skills 3 Flashcards
5 Mechanisms of Murmers
Increased flow through normal structures (anemia/pregnancy)
Flow across partial obstruction
Ejection into a dilated chamber
Regurgitant flow across incompetent valve
Abnormal Shunting
Systolic Loudness Grades (General Outline and Big Point)
Not too reliable for severity
1 - 3 go from barely audible to prominent
4-6 when you can feel a thrill, 6 when you can hear w/ stethoscope off chest
Diastolic Loudness Grades
Don’t really use, but 1-3 and 4 if thrill
3 Interventions
Stand Up - Decrease venous return, so most get softer (except cardiomyopathy)
Squat - increase VR and AL so most get louder (except cardiomyopathy)
Handgrip - Increase AL
4 Kinds of Systolic Ejection Murmurs
LV Outflow Obstruction - AS, HOCM (septal hypertrophy blocks exit)
Normal Flow over Deformed Valve - Bicuspid, Sclerosis
Flow into Enlarged Great Vessel - Aorta Dilatation
Increased Flow Over Normal Valve - “Functional”
2 Functional Flows
Innocent - Rapid ventricular ejection (youths, athletes)
Innocent Flow - Large SV for some reason - pregnancy, anemia, etc
Ejection Murmurs
Begin just after S1 w/ Diamond shape. Longer/later peak = more severe (AS)
Mitral Regurg Sound
Holoysystolic plateau “blowing” best heard at apex but often radiates to axilla
MR Severity
Determined by diastolic acoustic events: S3 w/ short murmur at early-mid diastole is more severe and means too much V
Aortic Regurg
High-freq decrescendo (bc pressure drops rapidly) starting at S2 best heard at L lower sternal border bc radiates backwards
2 Other Things that can come from AR
Systolic flow murmur/ejection bc too much V
Bifid pulse in carotid
How to Tell Age of AR
Chronic AR will last longer than acute bc vent has enlarged to accomodate and so pressure difference is less severe
Mitral Stenosis
Kinda hourglass low freq thing during diastole w/ dip in middle and presystolic accentuation (unless Afib) from atrial kick. Best heard at apex w/ bell. May have opening snap
MS Severity and Most Common Cause
Length of murmur and rheumatic fever
Continuous Murmur
High freq uninterrupted and peaks around S2. Usually from shunt like patent ductus arteriosus
