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CV R&M > Heart murmurs > Flashcards

Heart murmurs Flashcards

P 273. Complete.

1
Q

Holosystolic, high-pitched “blowing murmur”
Loudest at apex; radiates–>axilla.
Enhanced by maneuvers that increase TPR

A

Mitral regurg

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2
Q

Holosystolic, high-pitched “blowing murmur”
Loudest at LSB at 5th IC space; radiates–>RSB
Enhanced by maneuvers that increase RA return

A

Tricuspid regurg

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3
Q

Causes of MR (5)

A

IHD, MVP, LV dilation, ARF, IE

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4
Q

Causes of TR (3)

A

RV dilation, ARF, IE

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5
Q

Crescendo-decrescendo systolic ejection murmur
Loudest at heart base; radiates–> carotids
Pulses are weak w/ delayed pulse

A

Aortic stenosis

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6
Q

Holosystolic, harsh-sounding murmur
Loudest @ LSB at 5th IC space
Accentuated w/ hand grip

A

VSD

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7
Q

Late systolic crescendo murmur w/ midsystolic click. Heard best over apex; loudest just before S2. Occurs earlier w/ maneuvers that decrease venous return; later with those that increase SVR or venous return.

A

MVP

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8
Q

High-pitched “blowing” early diastolic decrescendo murmur.
Wide pulse P
Increased intensity w/ hand grip; decreased w/ vasodilators.

A

Aortic regurg

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9
Q

Delayed rumbling late diastolic murmur following the opening snap.
Enhanced w/ maneuvers that increase LA return
Smaller interval btwn S2 and OS= greater severity

A

Mitral stenosis

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10
Q

Continuous machine-like murmur

Loudest at S2; best heard at left infraclavicular area.

A

PDA

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11
Q

Cause of split S2 with inspiration

A

physiologic

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12
Q

Cause of widened splitting with expiration and inspiration

A

R bundle branch block

pulmonary stenosis

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13
Q

Cause of fixed splitting with inspiration and expiration

A

atrial septal defect

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14
Q

Cause of paradoxical splitting

A

L bundle branch block

advanced aortic stenosis

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15
Q

Cause of diastolic opening snap

A

mitral stenosis

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16
Q

Where does the mitral regurg murmur radiate?

A

Axilla

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17
Q

What maneuvers enhance the MR murmur?

A

Those that increase TPR (squatting, hand grip)

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18
Q

What’s the best (auscultory) indicator of severity of MR?

A

Presence of S3

19
Q

Where does the TR murmur radiate?

A

RSB

20
Q

What maneuvers enhance the TR murmur?

A

Those that increase RA return (inspiration)

21
Q

Where does the AS murmur radiate?

A

Carotids

22
Q

What maneuver increases VSD?

A

Hand grip, because it increases afterload

23
Q

What maneuvers make MVP occur earlier?

A

Those that decrease venous return (standing, Valsalva)

24
Q

Which murmur causes weak pulses with a delayed pulse?

A

Aortic stenosis

25
Q

Which murmur causes bounding pulses and head bobbing?

A

Aortic regurg

26
Q

What increases intensity of AR murmur?

A

Hand grip

27
Q

What decreases intensity of AR murmur?

A

Vasodilators (bc they decr afterload)

28
Q

What correlates with increased severity of MS murmur?

A

Decreased time btwn OS and S2

29
Q

What maneuvers increase MS intensity?

A

Those that increase LA return (eg: expiration)

30
Q

What’s the primary determinant of forward:regurgitant flow ratio in MR?

A

LV afterload

31
Q

Systolic ejection murmur that increases in intensity with maneuvers that decrease venous return?

A

Hypertrophic cardiomyopathy

32
Q

How does inspiration affect the intensity of heart sounds?

A

Increases intensity of right-sided heart sounds

33
Q

What bedside maneuver increases systemic vascular resistance?

A

Hand grip

34
Q

Hand grip increases the intensity of which murmurs? (4)

A

MR
AR
MVP
VSD

35
Q

Hand grip decreases the intensity of which murmurs? (2)

A

AS

HCM

36
Q

Which 2 bedside maneuvers decrease venous return?

A

Valsalva (phase 2)

Standing

37
Q

What’s the main murmur that increases in intensity with decreased venous return?

A

HCM

38
Q

What bedside maneuver increases venous return and preload?

A

Rapid squatting

39
Q

How does afterload change with prolonged squatting?

A

Increases

40
Q

How does rapid squatting affect AS?

A

Increases intensity

41
Q

How does rapid squatting affect HCM?

A

Decreases intensity

42
Q

How does rapid squatting affect intensity of MVP?

A

Increases intensity

43
Q

How do hand grip, valsalva/standing, and rapid squatting affect timing of click and murmur in MVP?

A

Hand grip and rapid squatting: later onset

Valsalva/standing: earlier onset

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