Flipped Cards Heart Notes Flashcards
High-pitched, Blowing
Diastolic murmur @ Left Sternal Border
Widened Pulse Pressure
(/Bounding/Water Hammer)
Pulsus Bisferiens (double systolic pulsation)
Aortic Regurgitation
May cause Austin Flint murmur @ Apex:
Mid-Diastolic, low-pitched rumbling due to vibration of anterior leaflet of Mitral valve as it is buffeted simultaneously by the blood jets from both the left atrium and the aorta.
Caused by Aortic Dissection (terrible pain down back), Ankylosing Spondylitis, Syphillis, Marfan’s
Decrescendo Diastolic murmur
@ Left lower Sternal Border
Pulmonic Regurgitation
Secondary to Pulmonary Hypertension, Bacterial Endocarditis, or Tetralogy of Fallot
Difficult to hear bc of low right side pressures.
Difficult to distinguish from Aortic Regurge.
Low-Frequency, Rumble
Diastolic murmur @ Apex in Left Lateral Decubitus position
Thrill may be present
Mitral Stenosis
Caused by Rheumatic Fever or Endocarditis
Lead to LAH and CHF
Mid-Diastolic Opening Snap
Diastolic Murmur @ Left Sternal Border
Increased by Inspiration
Large A waves
Tricuspid Stenosis
May cause S1 split
Often accompanied by Mitral Stenosis.
Almost always due to Rheumatic Fever.
Rare.
Continuous, “machine-like” murmur
@ Left Sternal Border
JVD
Widened Pulse Pressure
Thrill often present
Patent Ductus Arteriosus (PDA)
Exertional Dyspnea, Poor Feeding, increased pulmonary pressures
Prostaglandin E1 (open) Indomethacin (close)
= some blood from left heart returns to lungs
Systolic murmur
Radiates to Back
Diminished Femoral Pulses
BP higher in Upper extremities than Lower
Rib Notching
Coarctation of Aorta
Usually at descending aorta.
Increased risk for Aortic Dissection, Heart Failure, Endocarditis.
Cyanotic @ Birth
Systolic murmur @ Left Sternal border
Radiates to Left Carotid
Parasternal Heave
Tet Spells and squatting
Tetralogy of Fallot: VSD, Pulmonic Stenosis, Dextroposition of Aorta, RVH
Parasternal heave due to RVH.
Central cyanosis with exertion or agitation; may squat to alleviate.
Failure to thrive (poor growth and; development), loss of consciousness, clubbing, poor feeding.
Fixed S2 Split
Systolic murmur @ Pulmonic area
Radiates to Back
Atrial Septal Defect (ASD)
(Murmur due to increase flow over pulmonic valve)
May have brief diastolic murmur of flow across the tricuspid from ASD.
Dyspnea, Frequent Respiratory Infections (b/c Pulmonary Congestion), Palpitations.
Symptoms usually manifest by age 30.
Mostly asymptomatic if small defect.
Large defect closed surgically.
Increased risk for Endocarditis, Heart Failure, Atrial Fibrillation (b/c RA dilation, causing arrhythmia b/c that is where SA node is).
Holo-Systolic murmur @ Left Sternal border
Loud, High-pitched, Coarse
Late Cyanosis (Cyanosis Tardive) weeks after birth or age 1-2.
Ventricular Septal Defect (VSD)
Blue spells, tachypnea, Dyspnea, Failure to thrive, excessive work to feed.
Most small defects close spontaneously.
Good outcome for surgery on larger defects.
Can cause Eisenmenger’s Syndrome and RVH.
Holo-Systolic murmur @ Left Sternal border
Low-frequency
Decreased by Valsalva
S3 and Thrill are common
Large V waves
Absent x descent
Tricuspid Regurgitation
Hepatojugular Reflux: press on Liver to increase JVP.
Enlarged liver (hepatomegaly)
Parasternal heave b/c RVH
Mostly asymptomatic.
Caused by congenital, bacterial endocarditis, pulmonary hypertension, trauma.
Rare.
Mid-Systolic murmur @ Pulmonic area
May radiate to Neck or Back
Decreased by Valsalva
Large A wave
Delayed/Split S2
RV Heave and Thrill
Displaced/Widened Apical Impulse (PMI) @ sternum
Hx of heart murmur since birth
Pulmonic Stenosis
Mostly asymptomatic
Hx of Heart Murmur since Birth
Mid-Systolic murmur @ Aortic area (RUSB)
May radiate to Neck
Paradoxical S2 Split (Split during Expiration) (Pulmonic valve closes before Aortic)
Pulsus Tardus (delayed systolic upstroke)
Decreased by Valsalva
Aortic Stenosis
Angina, Exertional Fatigue, Dizziness, Syncope.
Crescendo-decrescendo
Caused by congenital bicuspid valve, Aortic sclerosis (aging), Rheumatic disease.
Leads to LVH, CHF
Systolic murmur @ Left Sternal border
Increased by Valsalva and Standing
Decreased by Squatting
May have Pulsus Bisferiens, Double Apical Impulse, Double Heave
Hypertrophic Cardiomyopathy (HOCM)
May have mitral regurgitation if both LV walls hypertrophy.
Often asymptomatic until exert.
Dyspnea, SOB, Angina, palpitations, lightheaded, Syncope, CHF. Sudden death.
(Symptoms present like Aortic Stenosis. But aortic stenosis is decreased by Valsalva )
Mid-Systolic Click
Increased by Valsalva and Standing
Decreased by Squatting
Mitral Valve Prolapse
Sometimes followed by a late systolic murmur.
May or may not cause mitral regurgitation.
Both the murmur and click move closer to S1 (right after S1) and get louder and longer with Valsalva and Standing. Opposite with Squatting.
Mostly asymptomatic.
Chest pain, SOB, Anxiety.
Caused by Marfan’s, Grave’s disease (Hyperthyroid)
Holo-Systolic murmur @ Apex
Radiates to Axilla
Increased by Squatting
S3 often present
Mitral Regurgitation
Mostly asymptomatic
Caused by Rheumatic heart disease, Mitral Valve Prolapse, Endocarditis, Marfan’s, MI
