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Echo > Heart Murmur > Flashcards

Heart Murmur Flashcards

1
Q

Normal Heart Sound

Consists of ____ & _____ sound

A

S1 & S2 or lab dab

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2
Q

Normal Heart Sound

S1 caused by…

A

AV valves closure

*start of systolic ventricular contraction

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3
Q

Normal Heart Sound

S2 sound is caused by…

A

semilunar valves closure

*once systolic contraction is complete

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4
Q

Murmur

Features of Murmur:

SCRIPT

What are the characteristics?

A
  • Site: where is the murmur loudest?
  • Character: soft? blowing? crescendo? decrescendo? crescendo decrescendo?
  • Radiation: carotid (AS)? axilla (MR)?
  • Intensity: grade of murmur?
  • Pitch: high? low and grumbling? indicate velocity
  • Timing: systolic? dyastolic?
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5
Q

Murmur

location associated with the heart sound

aortic area?

A

2nd right intercostal space

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6
Q

Murmur

location associated with the heart sound

pulmonic area?

A

2nd left intercostal space

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7
Q

Murmur

location associated with the heart sound

tricuspid area?

A

4th left intercostal space

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8
Q

Murmur

location associated with the heart sound

mitral area?

A

5th left intercostal space (midclavicular)

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9
Q

Murmur

murmurs are diagnosed based on:

A
  • Time they occur in the cardiac cycle: systolic or diastolic?
  • Shape: change in intensity over time
  • Location: auscultation site where they are best heard
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10
Q

Systolic Murmurs

MR

A
  • high pitched, blowing holosystolic (pansystolic) murmur that r_adiates to the_ axilla; it may be described as a blowing or high-pitched murmur
  • holosystolic - chronic
  • early systolic - acute
  • S3, S4 with heart failure
  • accentuated P2 with PH

*murmur starts at S1 when the AV valves are closed

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11
Q

Systolic Murmurs

TR

A
  • high pitched, holosystolic, blowing murmur that increases with inspiration
  • diastolic flow rumble
  • paradoxic splitting of S2

*loudest in the tricuspid area and the sound radiates up, along the left sternal border

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12
Q

Systolic Murmurs

AS

A
  • low pitched, harsh, systolic crescendo decrescendo murmur best heard at the right upper sternal border that may radiates up to the carotid artery

*often preceded by an ejection click caused by the opening of the stenotic valve

  • diastolic murmur if AR is present
  • S3, S4 with heart failure

*since the valve area is small, the blood flow starts small, rise to a maximum in mid-systole at the peak of ventricular contraction, then attenuates towards the end of systole

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13
Q

Systolic Murmurs

Pulmonic stenosis

A
  • medium pitched, harsh, crescendo decrescendo systolic ejection murmur
  • heard at the left upper sternal border (pulmonic area); a thrill may also be present

*

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14
Q

MVP murmur

A
  • Mid-systolic click
  • mid-to-late systolic murmur if MR present
  • click and murmur occur earlier n systole with preload reduction (valsalva, standing)
  • click and murmur occur late in systole with increased ventricular volume (squatting)
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15
Q

What is murmur?

A

A cardiac murmur is caused by turbulent blood moving through the heart of great vessels. Murmurs are categorized by their location, timing, intensity, configuration, pitch and quality.

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16
Q

Murmur

location

A
17
Q

Murmur

timing

A
  1. systolic, diastolic, continuous
  2. systolic murmur: early, mid, late, holosystolic (pansystolic)
  3. diastolic murmur: early, mid, late
18
Q

Murmur

intensity *graded on a scale of I to VI

A

I: barely audible

II: faintly heard

III: moderately loud

IV: loud

V: very loud

VI: loud with a thrill ( can be heard with a stethoscope)

19
Q

Murmur

Configuration

“A murmur is described by its change in intensity.”

A
  1. Crescendo murmur – begins softly and becomes louder
  2. Decrescendo murmur – begins loud and becomes softer
  3. Crescendo-decrescendo murmur-begins softly, become louder, and then decreases in intensity
  4. Decrescendo-crescendo murmur – begins loudly, becomes softer, then builds to the original intensity
20
Q

Murmur

pitch

“The pitch of a murmur is determined by the blood flow velocity.”

A

High pitched murmur – best heard with the diaphragm

Low pitched murmur – best heard with the bell of the stethoscope

Medium pitched murmur – best heard with both diaphragm and bell of the stethscope

21
Q

Murmur

quality

A

“A murmur’s quality may be described as blowing, rumbling, harsh, dull or rasping.”

22
Q

Other Systolic Murmurs

Early systolic murmurs: begin with
the first heart sound and end in midsystole

what are the causes?

A
  1. Small VSD
  2. Large VSD with Pulmonary HTN
  3. Severe acute or tricuspid regurgitation
23
Q

Other Systolic Murmurs

Systolic ejection murmurs: begin after the semilunar valves open

What are the causes?

A
  1. Valvular aortic or pulmonic stenosis
  2. Dilatation of the aorta or pulmonary artery
  3. Increased rate of ejection (heart block, fever, anemia, exercise,
    thyrotoxicosis, and sometimes heard in normal individuals)
24
Q

Pansystolic (holosystolic) murmurs: Present when there is
flow between two chambers that have widely different pressure
throughout systole, such as the left ventricle and the left atrium in MR

What are the causes?

A
  1. MR or TR
  2. VSDs
  3. Aortopulmonary shunts
25
Q

Other Systolic Murmurs

Late systolic murmurs: faint or moderately loud high-pitched apical murmurs start well after ejection and do not mask either normal heart sound

What are the causes?

A
  1. Papillary muscle dysfunction in patients with myocardial ischemia or infarction
  2. Late systolic murmurs following midsystolic clicks are associated with late systolic
    MR caused by MVP
26
Q

Diastolic Murmurs

AR

A
  • high-pitched, early, blowing, diastolic decrescendo murmur at the left sternal border
  • location: aortic area
  • secondary systolic ejection murmur
  • S3, S4 with heart failure
  • severe AR murmur is a low-pitched, mid-diastolic, rumble at the apex (Austin Flint murmur)
27
Q

Diastolic Murmurs

PR

A
  • high or low-pitched, blowing decrescendo diastolic murmur that may increase with respiration
  • Loud P2 with PH
  • Systolic ejection murmur with severe PR due to increased flow
  • Location: Erb’s point

*When PH is present with PR, a high-pitched blowing diastolic murmur may be heard (Graham-Steele Murmur)

28
Q

Diastolic Murmurs

MS

A
  • low-pitched, diastolic, rumbling, crescendo-decrescendo murmur with opening snap
  • loud S1
  • holosystolic murmur with MR
  • accentuated P2 with PH
  • location: mitral area
29
Q

Diastolic Murmurs

TS

A
  • high-pitched, diastolic rumble with respiration and opening snap
  • Absence of normal respiratory splitting of S2
  • Murmur of TR
  • Location: Tricuspid area
30
Q

Other Diastolic Murmur

Early diastolic murmurs: begin immediately after the second heart sound

What are the causes?

A
  • AR
  • PR
31
Q

Other Diastolic Murmur

Mid-diastolic and late diastolic murmurs: produced by the forward flow of blood through the atrioventricular valves

What are the causes?

A
  1. MS
  2. TS
  3. Left atrial myxoma (which may simulate a “stenotic” valve)
  4. MR (increased flow)
  5. Large left-to-right shunts (increased flow)
32
Q

continuous murmurs: result from blood flow constantly moving from a high-pressure area to a low-pressure area

What are the causes?

A
  1. PDA
  2. Systemic arteriovenous fistula
  3. Coronary artery from the pulmonary artery
  4. Communications between the sinus of Valsalva and the right side of the heart
33
Q

Murmurs

Response to Physiologic Maneuvers:

Valsalva Maneuvers

A

Most murmurs decrease during the strain phase of the Valsalva maneuver except hypertrophic obstructive cardiomyopathy and mitral valve prolapse

34
Q

Murmurs

Response to Physiologic Maneuvers:

Isometric Handgrip

A

Sustained isometric handgrip increases peripheral resistance, blood pressure, heart rate and cardiac output. The handgrip increases the left heart murmurs of MR, AR, VSD. The murmurs of semilunar valve stenosis and
hypertrophic cardiomyopathy will be reduced with sustained
isometric handgrip.

35
Q

Cardiac Maneuvers

Inspiration…

A

accentuates right-side heart murmur such as TR and TS

*inspiration = increase preload to right heart due to decrease in thoracic pressure

*If heart sound is louder during inspiration = right-sided lesion i.e. TR/TS/PR/PS, myxoma in the RV

*key word: increase with inspiration

36
Q

Cardiac Maneuvers

Valsalva

A
  • increases abdominal pressure = compress veins = reduce the blood flow returning to the heart
  • reduced preload
37
Q

Cardiac Maneuvers

Squatting

A
  • easier for the blood in the vein in your legs to return to the heart
  • increase preload
38
Q

Murmurs

Response to Physiologic Maneuvers:

Amyl Nitrite

A

Amyl nitrite is a fast acting vasodilator.

The inhalation of amyl nitrite will initially decrease venous return and blood pressure.

It will augment left ventricular outflow tract obstruction murmurs such as hypertrophic obstructive cardiomyopathy.

MVP may be enhance with amyl nitrite
inhalation.

Amyl nitrite will decrease the murmurs of AR, MR, and VSD.

The forward flow murmurs such as MS increase with the administration of amyl nitrite.

Echo (35 decks)

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