Heart Murmurs Flashcards
Radiation
- AS
- AR
- MS
- MR
- carotid arteries
- L upper sternal border
- no radiation
- axilla
stenosis vs. regurgitation
- harsh/rumble
- blowing
- stenosis, pressure overload
- regurgitation, volume overload
what murmurs are accentuated by leaning forward
aortic murmurs
what murmurs are accentuated by lying on left side
mitral murmurs
What does increased venous return do to murmurs
- exception
- increases
- decreases hypertrophic cardiomyopathy and delayed ejection click
What does decreased venous return do to murmurs
- exceptiond
- decreases
- increases hypertrophic cardiomyopathy and earlier ejection click
what murmurs are increased by:
- inspiration
- expiration
- right side
- left side
what do the following do:
- squatting
- handgrip
- increases venous return
- increases after load = reduced LV emptying
AS
- systolic ejection click
- crescendo-decrescendo
- RUSB
- dec with valsalva, standing, handgrip
- inc with venous return (squatting), sit and lean forward
**rely on preload to maintain CO = avoid physical exertion/dilation and negative inotrops (CCB, BB)
AR
- causes
- rheumatic fever
- endocarditis
- aortic root disease/dilation (HTN, marfan, etc.)
AR
- murmur
- diastolic decrescendo
- blowing
- LUSB
- incr: squatting, sitting forward, handgrip, expiration
- dec: valsalva, standing
AR
- tx
- after load reduction: vasodilators to improve forward flow (ACEi, ARB, Nifedipine)
MS
- cause
- rheumatic heart disease **
MS
- s/sx
- dyspnea, hemoptysis, pulmonary HTN
- a fib
- R sided HF
- ruddy flushed cheeks with facial pallor
MS
- murmur
- opening snap
- early-mid diastolic rumble
- apex
- louder in LLD position
- incr with venous return (squatting)
- dec with reduced venous return (valsalva, standing)
Mitral regurg
- cause
- MC: mitral valve prolapse
- papillary muscle dysfunction
Mitral regurg
- clinical presentation
- blowing, holosystolic murmur
- apex
- radiates to axilla
- widely split S2 (pulmonary HTN)
- incr with handgrip, LLD, squatting
- decr with valsalva, standing,
Mitral regurg
- heart changes
- LV volume overload
- LA dilation = inc pulmonary pressure and reduced CO
Mitral regurg
- reapir
- vasodilators to reduce afterload
Mitral valve prolapse
- mid-late systolic ejection click
- apex
- earlier click: valsalva, standing
- later click: squatting
PS
- etiology
- almost always congenital
- disease of the young like rubella
PS
- murmur
- harsh
- mid systolic ejection crescendo-decrescendo
- radiates to neck
- LUSB max sound
PR
- murmur
- brief decrescendo early diastolic murmur at LUSB
- louder with full inspiration
TS
- murmur
- mid-diastolic murmur at LLSB (4th ICS)
TR
- murmur
- holosystolic blowing
- high-pitched
- L mid sternal border
- louder with inspiration
