CV exam Flashcards
stills murmur
benign, midsystolic, louder supine
split S1
normal if heard LSB
if RSB then prob RBBB
split S2
normal- gets wider w/inhalation and dcreases w/exhalation
abnormal if fixed, RBBB or PS
S3
early diastolic best at apex normal up to age 30 noncompliant ventricle LV path (mitral regurg or dilated cardiomyopathy)
S4
late diastole just after atrial contraction
best at apex in left lat decubitus
caused by virbration from atrial kick
low pitched, quiet, bell
S4 etiology
thickening and stiffening of ventricular walls HTN AS PS hypertrophic cardiomyopathy
gallop rhythm
all 4 sounds technically
ejection cilck
sound occurring at moment of maximal pressure w/sudden tensing of valve root
aortic ejection click
early systolic at onset of LV ejection aortic root stretches dilated aneurysm of aorta COA HTN AS/AR
Aortic stenosis
systolic crescendo-decresceno
medium pitched
typically hard
transmits sound to carotid aa
pathology of AS
rheumatic disease
congenital bicuspid valve
calcification
symptoms of AS
dyspnea on exertion
angina
syncope
S4
AR
austin flint murmur
early diastolic high pitched blowing decrescendo
dilates LV -> S3
AR pathology
rheumatic disease
congenital bicuspid valve
endocarditis
pulmonary ejection click
sudden root tensing
very early systole
pulmonary ejection click pathology
PHTN
aneurysm dilating root
PS/PR
PS
systolic crescendo-decrescendo murmur
most asymptomatic and do not progress
severe PS symptoms
exertional dyspnea chest pain syncope dilated RV S4
PS etiology
congenital
carcinoid tumor
PHTN
PR
graham steel murmur
softer diastolic decrescendo
PR path
PHTN MS LV failure obstructive sleep apnea emphysema
tricuspid stenosis
diastolic low pitched rumble, bell
opening snap
accentuated by inspiration
increases CVP
tricuspid pathology
RD
congenital HD
carcinoid tumor
TR
early pansystolic
diaphragm
will not radiate to left axilla
inspirational accentuation
TR path
ebstein congenital anomaly
mitral valve opening snap
stenotic mitral leaflets are tethered at orifice, but still mobile
MS
diastolic
can be w/opening snap
can cause PHTN, elevated JVP, RV hypertrophy
MS path
almost always from RD
MP
mid to late systolic click at apex that may or may not be followed by a murmur
high pitched short murmur
MR
holosystolic
loud high pitched
can radiate to left axilla
MR etiology
endocarditis
RD
post MI pap mm rupture
squatting
increases preload
decreases MP and hypertrophic cardiomyopathy murmur
increases AD
standing
decreases preload
increases MP and hypertrophic cardiomyopathy murmur
decreases AS
IHSS
idiopathic hypertrophic subaortic stenosis
symptoms same as AS- exertional dypsnea, angina, syncope
IHSS murmur
systolic ejection murmur along left sternal border and apex, often accentuated PMI
PDA
murmur through systole and diastole
best at pulmonic
may have thrill
constrictive pericarditis
pericardial knock
inflamed pericarditis
rub
more in systole
leaning forward accentuates
4 main risk factors of vascular disease
smoking
DM
HTN
hyperlipidemia
mitral valve prolapse
often present w/complaint of symptom of palpitations
young women
at risk for arrhythmia if there is also dilated LA
carotid bruit
can be atherosclerosis, primary stenosis at carotid or a radiating aortic stenosis
at risk for stroke
