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Cardiology > Heart Murmurs > Flashcards

Heart Murmurs Flashcards

1
Q

What is the definition of a heart murmur?

A

The sound detected when TURBULENT BLOD FLOW occurs:
- through the great vessels or
- across a heart valve

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2
Q

What are the most common types of heart murmurs?

A

Valves:
- Aortic
- Mitral

Descriptions*:
- Stenotic: does not OPEN properly
- Regurgitant: does not CLOSE properly

*Both are mechanical problems that can become electrical

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3
Q

How are heart murmurs identified?

A

Systolic vs Diastolic:
- Systolic = in sync with carotid pulse
- Diastolic = out of sync with carotid pulse

Aortic vs Mitral (which valve):
- heard loudest at respective listening points

Associated findings

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4
Q

Where are the aortic and mitral listening points?

A

Aortic listening point:
- 2nd intercostal space
- Right eternal border

Mitral listening point:
- apex of heart

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5
Q

When should heart murmurs be referred?

A

Diastolic murmurs are ALWAYS ABNORMAL and should ALWAYS be referred!**

Systolic murmurs with associated findings should USUALLY be referred, especially with:
- HF
- angina

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6
Q

Name a pneumonic for recalling systolic (vs diastolic) murmurs.

A

Systolic Murmurs pneumonic: MR Peyton Manning AS MVP

          MR:   Mitral Regurgitation

   Peyton    Physiologic
Manning:   Murmur

           AS:   Aortic Stenosis

        MVP:   Mitral Valve Prolapse
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7
Q

Name a pneumonic for recalling diastolic (vs systolic) murmurs.

A

Diastolic Murmurs pneumonic: ARMS***

AR: Aortic Regurgitation
MS: Mitral Stenosis

***Diastolic murmurs are ALWAYS ABNORMAL and should ALWAYS be referred!!!

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8
Q

How are mitral regurgitation heart murmurs identified, including assessment findings, radiograph findings and EKG results?

A

Assessment findings r/t identification:
- systolic (in sync with carotid artery pulse)
- heard at mitral listening point of 2nd intercostal space at right sternal border

Radiograph findings include enlargement of:
- Left ventricle
- Left atrium

EKG results:
- A-fib is common

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9
Q

Name common etiologies of mitral regurgitation heart murmurs.

A
  • Congenital
  • Rheumatic heart disease
  • Acute endocarditis
  • Calcified annulus
  • Mitral valve prolapse (may or may not be related to rheumatic heart disease)
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10
Q

Describe the common course for mitral regurgitation heart murmurs.

A
  • Long asymptomatic period
  • Congestive heart disease at 40 - 60 years old
  • Decline over about 10 years
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11
Q

What are common associated findings with mitral regurgitation murmurs?

A
  • Shortness of breath
  • Fatigue
  • Heart failure/Congestive heart failure
  • Bacterial endocarditis
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12
Q

How are aortic stenosis murmurs identified, including assessment findings, radiograph findings, and EKG results?

A

Assessment findings r/t identification:
- systolic (In sync with carotid artery pulse)
- heard at apex of heart

Radiograph findings:
- late cardiomegaly

EKG results:
- usually normal

***Aortic stenosis is often on exam!!!

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13
Q

Name common etiologies of aortic stenosis heart murmurs.

A
  • Ages 15 - 65
  • Congenital - #1 most common cause
  • Rheumatic fever - #2 most common cause
  • Mitral valve prolapse - usually involved if d/t rheumatic fever
  • Calcified valve
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14
Q

Describe the common course for aortic stenosis heart murmurs.

A
  • Long asymptomatic period
  • Rapid decline (usually around ages 50 - 60 years)
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15
Q

What are common associated findings with aortic stenosis murmurs?

A

Angina:
- 2/3 patients develop angina
- 1/2 patients also develop CAD

Syncope:
- often preceded by dizziness
- usually exertional

CHF:
- dyspnea
- rapid decline at this point

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16
Q

What assessment findings indicate mitral valve prolapse murmurs?

A

Assessment findings r/t identification:
- Systolic (in sync with carotid artery pulse)
- Click at mitral listening point:
- Initial: Midsystolic click heard at apex and left sternal border
- Later: Late diastolic click - worse with standing, quieter with squatting

17
Q

What are common radiograph and EKG findings related to mitral valve prolapse murmurs?
What is the common course?

A

Radiograph/EKG findings:
- EKG usually normal

Course:
- most patients are asymptomatic

18
Q

Name common etiologies of mitral valve prolapse murmurs.

A
  • Degeneration of mitral valve tissue/redundancy of mitral valve leaflets
  • Common in women aged 14 - 30 years
19
Q

What are common associated findings with mitral valve prolapse murmurs?

A

Palpitations:
- PACs/PVC’s more common with exercise

Chest pain

20
Q

How are aortic regurgitation murmurs identified, including assessment findings, radiograph findings, and EKG results?

A

Assessment findings r/t identification:
- Diastolic (not in sync with carotid artery pulse)
- Heard at aortic listening point at 2nd intercostal space at right sternal border

Radiograph - LATE finding:
- VERY large and dilated left ventricle

EKG results:
- Evidence of left ventricle hypertrophy

21
Q

Name common etiologies of aortic regurgitation murmurs.

A
  • Rheumatic heart disease
  • Syphilis
  • Congenital deformity
  • Aortic root abnormalities
22
Q

Name the common course of aortic regurgitation murmurs.

A
  • Prolonged asymptomatic period (even with exercise)
  • Late decreased exercise tolerance
  • Very late CHF
23
Q

What are common associated findings with aortic regurgitation murmurs?

A
  • Angina
  • CHF
  • Dizziness
  • Chest pain
  • Wide pulse pressure
  • “Water hammer pulse” = wide and quick arterial pulses
24
Q

How are mitral stenosis murmurs identified, including assessment findings, radiograph findings, and EKG results?

A

Assessment findings r/t identification:
- Diastolic (not in sync with carotid artery pulse)
- Heard at mitral listening point at apex

Radiograph finding:
- Enlarged left atrium

EKG results:
- A-fib

25
Q

Name the etiology of mitral stenosis murmurs. Describe the associated course, including average age of death.

A

Etiology: Rheumatic fever

Course :
Stage 1: - Long asymptomatic period of about 20 years
- Gradual reduction in exercise tolerance over about 3-5 years
Stage 2: - Onset of pulmonary congestion
Stage 3: - Development of pulmonary hypertension
Stage 4: - Severe state of low cardio output

Average age of death: 48 years
-

26
Q

What are common associated and physical exam findings with mitral stenosis murmurs?

A

Associated findings:
- Dyspnea (most common)
- A-fib (common)
- Hemoptysis (from increased pulmonary pressure)
- Left ventricular hypertrophy

Physical exam findings:
- Loud S1
- Apical diastolic murmur radiating to axilla

Cardiology (8 decks)

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