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POM unit 4 > heart murmurs > Flashcards

heart murmurs Flashcards

1
Q

what to look for on inspection

A

look at the patient overall. signs of diminished cardiac output, HF, atherosclerotic disease. look for PMI

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2
Q

aortic valve space?

A

second right intercostal space at the right sternal border.

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3
Q

pulmonic valve space

A

second left intercostal space at the left sternal border

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4
Q

second pulmonic valve space

A

third left intercostal space at the left sternal border.

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5
Q

tricuspid valve space

A

fourth left intercostal at left sternal border.

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6
Q

mitral valve space

A

at the apex. the fifth intercostal space at the midclavicular line

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7
Q

how should we listen to the heart sounds?

A

with the patient in 2 different positions

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8
Q

what is the best position for listening to high-pitched sounds

A

sitting up and leaning slightly forward.

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9
Q

what is the best position for listening to low-pitched sounds?

A

left lateral decubitus position

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10
Q

what is the lub or S1?

A

this represents closure of the mitral and tricuspid valves or the beginning of systole. corresponds to the upstroke of the carotid pulse.

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11
Q

where is S1 heard best?

A

at the apex.

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12
Q

what is the dub or the S2

A

represents the closure of the aortic and pulmonic valves and signals the end of systole.

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13
Q

where is S2 heard the loudest?

A

heard loudest at the base of the heart.

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14
Q

S3

A

kentucky gallop. represents the passive diastolic filling of the ventricle. this is heard immediately after S2 and when the filling pressure is elevated. it is a low pitched sound heard best at the apex with the bell.

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15
Q

what position is best for hearing the S3?

A

left lateral decubitus position

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16
Q

when is the S3 normal?

A

in children and young adults

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17
Q

S4

A

tennessee gallop. represents active atrial filling of the ventricle -the second phase of ventricular filling. occurs immediately before S1. this is louder than S3. best heard at the apex.

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18
Q

what position is best for S4?

A

lateral decubitus or supine. still heard the best with the bell at the apex.

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19
Q

when is the S4 common?

A

left ventricular hypertrophy and myocardial ischemia.

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20
Q

murmur?

A

caused by distortion of blood flow through the heart.

21
Q

what is the primary cause of a murmur?

A

malfunction of a valve disrupting blood flow

22
Q

how do we describe a murmur

A

timing (systolic/diastolic) pitch, pattern, location, radiation

23
Q

grade 1 murmur

A

barely audible

24
Q

grade II murmur

A

quiet, intensity similar to S1/S2

25
Q

grade III murmur

A

moderate.

26
Q

grade IV murmur

A

loud with a thrill

27
Q

grade V

A

very loud and easily palpable thrill

28
Q

grade VI murmur

A

audible with stethoscope off of chest

29
Q

examples of systolic murmur

A

mitral regurg and aortic stenosis

30
Q

mitral regurgitation when?

A

can be early systolic, late systolic, holosystolic

31
Q

mitral regurgitation heard best where?

A

over the apex

32
Q

where does mitral regurgitation radiate?

A

to the back and the clavicle.

33
Q

what changes the intensity of the mitral regurgitation

A

isometric exercise will increase

34
Q

aortic stenosis when?

A

considered a mid-systolic murmur

35
Q

what is the character of aortic stenosis

A

crescendo-decrescendo

36
Q

where is aortic stenosis heard best?

A

in the aortic region

37
Q

where does aortic stenosis radiate?

A

to the neck.

38
Q

how do we change the intensity of aortic stenosis and how does it change?

A

isometric exercise decreases. squatting increases

39
Q

what happens to S2 when A2 becomes softer?

A

it decreases in intensity

40
Q

examples of diastolic murmurs

A

aortic regurgitation or mitral stenosis

41
Q

aortic regurgitation heard best where?

A

in the 3rd left intercostal space.

42
Q

where does aortic regurgitation radiate

A

along the left sternal border

43
Q

what is the nature of aortic regurgitation

A

early diastolic and decrescendo in nature

44
Q

how do we change the intensity of aortic regurgitation and how does it change?

A

increases with isometric exercise and squatting

45
Q

where is mitral stenosis heard best

A

over the apex

46
Q

what is the character of mitral stenosis

A

low pitched rumbling so remember the left lateral position

47
Q

when for the mitral stenosis

A

mid-diastolic murmur that extends in duration as stenosis worsens

48
Q

how do we change the intensity and how does it sound?

A

isometric exercise will increase the murmurs intensity

POM unit 4 (5 decks)

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