Final: Concepts in Cardiac and Heart Sounds DSA Flashcards
What can cause a fixed split S2?
Usually an ASD, but R HF can cause it too
What is the most common cause of a delayed A2 that moves closer to P2 on inspiration?
LBBB is the main cause of paradoxical splitting
When is an S3 sound heard?
Normal in children, in adults its due to volume overload and dilated cardiomyopathy
D=S3
What does an S4 sound mean?
Atrial contraction against a non-compliant ventricle
When would you hear an S4?
Ventricular hypertrophy in:
- Aortic stenosis
- HTN
- Hypertrophic cardiomyopathy
- CAD
What pathology would cause an opening snap followed by a diastolic rumble?
Mitral stenosis
-usually due to rheumatic heart disease
Mid systolic click followed by a late systolic murmur?
Mitral valve prolapse
-common in younger women and Marfans
What grade of murmur: a very faint murmur, that youd have to listen for 5-6 beats while being tuned it?
Grade 1
What grade of murmur: Quite, but still heard after a few beats?
Grade 2
What grade of murmur: moderately loud, no thrill
Grade 3
What grade of murmur: moderately loud, with thrill
Grade 4
What grade of murmur: loud, thrill, heard with stethoscope partly off chest
Grade 5
What grade of murmur: very loud, heard without stethoscope
Grade 6
This pathology is the most common murmur in elderly. Due to abnormal calcification. Presents as cresendo-decresendo systolic murmur that radiates to the neck. You may also hear an S4 gallop.
Aortic stenosis
What can cause aortic stenosis in those less than 50?
Bicuspid aortic valve
What is the classic triad of aortic stenosis?
HF, angina, and syncope
What is an Austin-Flint murmur?
It is due to rheumatic heart disease where you have both an AS and MS murmur
Can you treat AS with vasodilators?
No, actually can make it worse. Usually valve replacement is the first choice
This murmur is an early diastolic decresendo murmur. Heard best at the left sternal boarder (3rd space)
Aortic regurge
What are some common causes of aortic regurge?
Endocarditis (valve deformity) and Type A dissection
-expect cardiogenic shock symptoms!
Also syphilis
What can chronic AR cause?
LV hypertrophy and volume overload, leading to left heart failure
What is treatment of choice for aortic regurge?
ACEi/ARBs + diuretics
This murmur is a holosystolic murmur that radiates to R sternal boarder that increases in intensity with inspiration.
Tricuspid regurge.
What are 2 common causes of tricuspid regurge?
- RV dilatation due to pulmonary HTN** or Left HF
- Acute endocarditis (staph aureus and IVDU)
also look out for carcinoid syndrome and ebstein anomaly
What conduction abnormality is common with mitral stenosis?
A-fib
How does the duration of time b/t S2 and the opening snap of MS compare to the severity of disease?
They are inversely related!
-the more severe the disease, the higher the LA pressure, the early the opening snap will be heard
What would a chest x-ray show on someone with a MS show?
- Prominent pulmonary artery vascularity
- An enlarged LA
- Normal sized LV
What is the most common congenital heart disease diagnosed in adulthood (after bicuspid aortic valve)?
An Atrial septal defect
If I said a systolic ejection murmur at LSB that causes a fixed split between P2 and A2, and can lead to A-fib?
ASD
What is the most common congenital defect in kids?
VSD
Do smaller or larger VSDs produce murmurs?
Smaller ones
-have to force the blood through a smaller hole
If I said a continuous, machine-like murmur that is heard at the LUSB and causes cyanosis of the LE and Pulmonary HTN, what would you say?
PDA
What is a rapid rise and fall with an elevated systolic and low diastolic pressure found in radial or brachial pressures a sign of?
Chronic aortic regurge
