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CVPR > CVPR Week 3: Listening to heart murmurs > Flashcards

CVPR Week 3: Listening to heart murmurs Flashcards

1
Q

What causes heart murmurs?

A

Turbulent flow

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2
Q

Turbulent flow

A

Forward flow

Backward flow

Shunt from left side circulation to right side or vice versa

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3
Q

What determines how loud a murmur is?

2 listed

A
  • Degree of turbulence
  • Shape and thickness of the chest wall
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4
Q

What determines the length of time a murmur can be heard?

A

Length proportional to the duration of turbulence

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5
Q

How do we describe murmurs?

5 listed

A
  • Timing *systole vs diastole)
  • Intensity
  • Location
  • Radiation
  • Frequency (pitch)
  1. Related to velocity
  2. Stethoscope to help distinguish frequencies
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6
Q

Stethoscope: Bell for?

A

Low frequencies

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7
Q

Stethoscope: Diaphragm for?

A

high frequencies

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8
Q

Grading of heart murmurs

A
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9
Q

Grade 1 Heart Murmur

A

Very faint

not always heard in all positions

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10
Q

Grade 2 Heart Murmur

A

quiet but not difficult to hear

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11
Q

Grade 3 Heart Murmur

A

moderately loud

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12
Q

Grade 4 Heart Murmur

A

Loud +/- thrills

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13
Q

Grade 5 Heart Murmur

A
  • Very loud +/- thrills
  • may be heard with stethoscope partly off the chest
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14
Q

Grade 6 Heart Murmur

A
  • may be heard with stethoscope completely off the chest
  • +/- thrills
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15
Q

Cardiac Auscultation sites

A
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16
Q

Shape of murmurs

A
  • Systolic
  • Diastolic
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17
Q

Evaluating Cardiac Murmurs

9 listed

A
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18
Q

Position of murmur

A
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19
Q

Position of murmur: Supine

A

General auscultation and most heart sounds

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20
Q

Position of murmur: Sitting up and leaning forward and holding exhalation

A
  • Aortic stenosis
  • aortic regurgitation
  • Pericardial rubs
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21
Q

Position of murmur: Left lateral decubitus

A

S3, S4, Mitral stenosis (using bell of stethoscope)

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22
Q

Position of murmur: Valsalva manoeuver

A

increases intensity of mitral valve prolapse and hypertrophic cardiomyopathy

decreases intensity of aortic stenosis

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23
Q

Position of murmur: Squating and standing

A
  • increases intensity of aortic stenosis
  • Decreases intensity of outflow obstruction in hypertrophic cardiomyopathy
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24
Q

Describe

A
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25
Q

Heart sound questions: S1

S1

A

C: During isovolumetric contraction

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26
Q

Heart sound questions: S2

S2

A

during isovolumetric relaxation

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27
Q

S3 occurs when?

A
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28
Q

S4 occurs when?

A
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29
Q

Pressure-volume loop

A
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30
Q

In what phase of the pressure-volume loop is this heart?

A

Isovolumetric relaxation

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31
Q

In what phase of the pressure-volume loop is this heart?

A

Ejection

32
Q

Echo imaging of the heart

A
33
Q

The most familiar form of imaging of the heart

A

Echo imaging of the heart

34
Q

Appears like a movie strip with continuous action through a slice of the heart

A

Echo imaging of the heart

35
Q

2D imaging produces a “thin slice” through the part of the heart being interrogated

A

Echo imaging of the heart

36
Q

Identify

A
37
Q

Current role of Echocardiography

A
38
Q

How is Echo used?

A
39
Q

Identify

A
40
Q

On the pressure-volume loop, when would one hear the murmur of aortic stenosis?

A
41
Q

What is this?

A

Aortic stenosis

42
Q

Where is aortic stenosis best heard?

A

right second intercostal space on the sternal border

43
Q

How is the sound of Aortic stenosis described?

A

as a crescendo-decrescendo systolic ejection murmur

44
Q

What is this?

A

aortic regurgitation

45
Q

Where is aortic regurgitation best heard

A

along the right sternal border in the 2nd intercostal space

46
Q

How is the sound of aortic regurgitation described?

A

It is described as an early diastolic decrescendo murmur

47
Q

aortic regurgitation can be present with?

A

a bounding pulse or wide pressure pulse

48
Q

common causes of aortic regurgitation?

A
  • Bicuspid aortic valve
  • endocarditis
  • Rheumatic fever
  • Aortic root dilation
49
Q

What is this?

A

S3 heart sound

This is the the sound of the S3 heart sound. It is heard normally in young adults and children, in pregnancy and athletes. It is abnormal older adults and may signify heart failure or cardiomyopathy.

50
Q

Best patient position to hear the S3 heart sound?

A
  • Left lateral decubitus position
  • on the cardiac apex in the 5th intercostal space
51
Q

S3 heart sound should be listed to with which part of the stethoscope?

A

The bell and should be faint or absent with the diaphragm

52
Q

S3 heart sound is produced by?

A

blood coming into contact with a compliant ventricle

53
Q

S3 heart sound in elderly may signify?

A
  • Heart failure
  • Cardiomyopathy
  • Severe mitral or tricuspid regurgiation
54
Q

How is the S3 heart sound described?

A

The S3 has a low pitch vs the split S2 which is high pitched

55
Q

What is this?

A

Holosystolic murmur

56
Q

Holosystolic murmur is produced by?

A

Typically caused by mitral & Tricuspid regurgitation

or

Ventricular septal defects

57
Q

Holosystolic murmur is best heard where?

A
58
Q

Holosystolic murmur radiation?

A
59
Q

Holosystolic murmur sound is described as

A

a high pitched blowing murmur

60
Q

Holosystolic murmur common causes

A
  • Mitral valve disease
  • Rheumatic fever
  • mitral valve prolapse
  • infective endocarditis
  • congenital abnormality through a hole in the interventricular septum
61
Q

What is this?

A

Normal heart sound

62
Q

What is this?

A

S4 heart sound

63
Q

Atrial gallop AKA

A

S4 heart sound

64
Q

The best place to hear the S4 heart sound?

A
  • lateral left decubitus position
  • with the bell of the stethoscope
65
Q

The S4 heart sound is a sign of?

A

Diastolic heart failure

66
Q

The S4 heart sound is produced by?

A

when the atria contract forcing blood into a non-compliant ventricle

often heard in severe left ventricular hypertrophy

67
Q

often heard in severe left ventricular hypertrophy

A

S4 heart sound

68
Q

Often heard during active cardiac ischemia

A

S4 heart sound

69
Q

What is this?

A

Mitral stenosis

70
Q

Mitral stenosis is best heard?

A
71
Q

Mitral stenosis is produced by?

A

rapid closing of thickened mitral valves

caused by the valve cusps snaping into the left ventricle

72
Q

Mitral stenosis sound is described as?

A

low-pitched decrescendo-crescendo rumbling diastolic murmur

73
Q

Mitral stenosis becomes louder by?

A

valsalva maneuver, squating or activities that increase afterload

74
Q

On the pressure-volume loop when would you hear the murmur of mitral stenosis?

A
75
Q

On the pressure-volume loop when would you hear the murmur of mitral regurgitation?

A
76
Q

Question

A

CVPR (93 decks)

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