Heart Murmurs

Question 1

Scale that heart murmurs are graded on?

Answer 1

I to XI

most are II or III

Question 2

Early to mid crescendo-decrescendo systolic murmur heard best over base and radiates to cardotids

Answer 2

Aortic Stenosis

Question 3

Etiology of aortic stenosis?

Answer 3

degenerative calcific
Rheumatic
Bicuspid

Question 4

Pathophysiology of aortic stenosis?

Answer 4

Pressure gradient over 50 mm or valve area represents a critical obstruction (1/3 of normal valve area)

Question 5

Symptoms of aortic stenosis?

Answer 5

angina
syncope
dyspnea on exertion

Question 6

Treatment of aortic stenosis

Answer 6

Valve replacement, balloon valvuloplasty in children and young adults

Question 7

Holosystolic murmor that is heard at apex and radiates to axilla?

Answer 7

Mitral Insufficiency/Regurgitation

Question 8

Etiology of Mitral Regurg.

Answer 8

Rheumatic heart disease, congenital, acute MI with papillary muscle dysfunction, endocarditis, calcification with age

Question 9

Pathophysiology of Mitral Regurg.

Answer 9

Decreased forward flow
If acute… little enlargement of LA, leading to PE
Chronic… large left atrium

Question 10

Symptoms of Mitral Regurg.

Answer 10

Acute: Pulmonary edema, acute shortness of breath
Chronic: severe fatigue, atrial fib.

Question 11

Treatment of Mitral Regurg.

Answer 11

Medial treatment for CHF, atrial fib.

Surgery if more severe

Question 12

Diastolic murmur heart best at apex with patient in left lateral recumbent position?

Answer 12

Mitral Stenosis

Question 13

Etiology of Mitral stenosis

Answer 13

Mostly rheumatic

Rarely congenital

Question 14

Pathophysiology of mitral stenosis?

Answer 14

Pulmonary HTN

Resultant right ventricular failure

Question 15

Symptoms of mitral stenosis?

Answer 15

Dyspnea with exertion and cough
hemoptysis
arterial embolism

Question 16

Treatment of mitral stenosis?

Answer 16

antibiotic prophylaxis
CHF
atrial fib.
valve replacement if less than 1.0 cm

Question 17

High pitched diastolic murmur best heard at base when patient is sitting?

Answer 17

Aortic Insufficiency/Regurg.

Question 18

Water hammer pulse?

Answer 18

Aortic Insufficiency

Question 19

Opening snap precedes murmur

Answer 19

Mitral stenosis

Question 20

Etiology of aortic insufficiency

Answer 20

2/3 rheumatic

Endocarditis, trauma, congenital

Question 21

Pathophysiology of aortic insufficiency

Answer 21

increased SV

deterioration of LV function precedes symptoms

Question 22

Symptoms of aortic insufficiency?

Answer 22

May be asymptomatic for years
Uncomfortable awareness of heartbeat lying down
Exertional dyspnea first symptom followed by orthopnea and PND angina
CHF

Question 23

Treatment of aortic insufficiency

Answer 23

Difficult to time - patient often asymptomatic until myocardial dysfunction develops
Myocardial dysfunction does not return after surgery

Question 24

Click-murmur syndrome

Answer 24

Mitral valve prolapse

Question 25

When is the click in mitral valve prolapse?

Answer 25

mid or late systolic, may be followed by a high pitched late systolic murmur heard best at apex

Question 26

Etiology of mitral valve prolapse

Answer 26

Congenital or genetic Very common Females between 14 and 30

Question 27

Pathophysiology of mitral valve prolapse

Answer 27

Myxomatous degeneration of posterior leaflet

Question 28

Mitral valve prolapse usually benign but may trigger _______

Answer 28

arrhythmias

Question 29

Treatment for mitral valve prolapse?

Answer 29

reassure?

Question 30

2 right sided murmurs?

Answer 30

1. Tricuspid stenosis | 2. Tricuspid regurg.

Question 31

Tricuspid stenosis

Answer 31

Rare in developed countries Rheumatic - associated with mitral stenosis Giant A wave in neck Diastolic murmur heard best along lower left sternal border and xiphoid

Question 32

Tricuspid regurg.

Answer 32

Functional from R ventricular dilation signs of R sided heart failure Holosystolic murmur at LLSB prominent v wave on neck

Question 33

A wave on neck?

Answer 33

Tricuspid stenosis

Question 34

V wave on neck?

Answer 34

Tricuspid regurg.

Question 35

Midsystolic murmur at 2nd and 3rd interspaces

Answer 35

Pulmonic Stenosis

Question 36

In a young person pulmonic stenosis is probably _____

Answer 36

benign

Question 37

Are systolic or diastolic murmurs innocent?

Answer 37

Systolic

Question 38

Ways murmurs are innocent

Answer 38

``` Systolic No physiological abnormalities Grade I or II No thrills or radiation Ends well before S2 Found in 30 to 50% of children ```