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PDX 1 > Heart Murmurs & Ischemia > Flashcards

Heart Murmurs & Ischemia Flashcards

1
Q

What happens during S1 in the cardiac cycle?

A

Closure of the mitral & tricuspid valves

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2
Q

What happens during S2 of the cardiac cycle?

A

Closure of the pulmonic aortic & pulmonic valves

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3
Q

Do the mitral & tricuspid valve open right after S1 or S2?

A

S2

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4
Q

What is the most common cause of murmurs?

A

disease of heart valve

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5
Q

What are the 2 main mechanisms of murmurs?

A
  1. Obstructed flow due to stenotic valve

2. Backwards flow through a leaky valve= regurgitation (aka insufficiency)

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6
Q

What are the 3 types of systolic murmurs?

A
  • Mitral regurgitation (MR)
  • Mitral valve prolapse (MVP)
  • Aortic stenosis (AS)
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7
Q

What are the 2 diastolic murmurs?

A 
Mitral stenosis (MS)
Aortic regurgitation (AR)
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8
Q

What artery pulse could you use to help you determine S1 and S2?

A

Carotid artery

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9
Q

Does the carotid pulse occur during systole or diastole?

A

During systole

S1 –> carotid pulse –> S2

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10
Q

Which valve is being described? Closed during systole, blood cannot flow backwards from LV to LA

A

Normal Mitral Valve

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11
Q

What happens during mitral regurgitation?

A

mitral valve allows backwards blood flow from LV to LV during ALL of systole.
AKA- holosystolic (pansystolic) murmur

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12
Q

When does mitral regurgitation occur during the cardiac cycle? What is the intensity like?

A

Occurs from S1 to S2

Same intensity throughout the murmur- doesn’t change

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13
Q

Where is mitral regurgitation best heard? Where might it radiate?

A

Apex

May radiate to axilla or posterior lung bases

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14
Q

What are the causes of mitral regurgitation?

A

Rheumatic heart disease (immigrants)
Post-myocardial infarction
CT diseases (ex= Marfans)
Mitral Valve Prolapse

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15
Q

Explain a mitral valve prolapse.

A

Redundant valve tissue with elongated chordae tendinae so the valve balloons up into the LA.
This causes an upward displacement of the mitral valve leaflets during systole

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16
Q

What is heard during a MVP? Where do you hear this best?

A

Mid-systolic click/ late systolic murmur

- Apex

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17
Q

Is aortic stenosis heard during systole or diastole?

A

Systole

known as a systolic ejection murmur

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18
Q

What does an aortic stenosis murmur sound like and where is it best heard? Radiates?

A

Crescendo-decrescendo

  • intensity increases then decreases again during systole
  • 2nd right intercostal space
  • radiates to the neck or heart apex
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19
Q

What are the causes of aortic stenosis?

A
  • congenital bicuspid valve (should be tricuspid)
  • more susceptible to wear & tear
  • calcific degeneration (in patients over 70)
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20
Q

What are the symptoms of aortic stenosis?

A

Triad:

  • Dyspnea on exertion- 75%
  • Angina- 10%
  • Presyncope- 10% / Syncope- 5%
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21
Q

How would aortic stenosis lead to heart failure?

A

Left ventricular outflow obstruction leads to left ventricular hypertrophy –> could lead to heart failure

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22
Q

Explain aortic regurgitation

A

due to retrograde flow of blood from aorta into the LV- the valve is supposed to be closed but is leaky

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23
Q

When do you hear aortic regurgitation and where is it best heard?

A

Early diastolic descrescendo murmur

- lower left sternal border- may get patient to lean forward & hold breath

24
Q

What are causes of aortic regurgitation

A

Congenital bicuspid valve
Rheumatic heart disease
CT disorders

25
Q

What can aortic regurgitation lead to?

A
  • volume overload in LV
  • combined LV hypertrophy & dilation
  • heart failure
26
Q

Explain mitral stenosis

A

partially obstructed flow of blood from LA to LV

27
Q

What does mitral stenosis sound like and where is it best heard? Radiate?

A
  • opening snap followed by a decrescendo diastolic rumble
  • apex
  • may have patient lie on left side
    • doesn’t radiate
28
Q

What can mitral stenosis lead to?

A
  • Elevated left atrial pressure
  • pulmonary hypertension
  • eventually right sided heart failure
    ( blood backs up into lungs causing R sided heart problems)
29
Q

What is the common cause of mitral stenosis?

A

Rheumatic fever

30
Q

What is a cause other than rheumatic fever for mitral stenosis?

A
  • history of long illness following a sore throat in childhood
31
Q

Which murmur typically has a 20 year latent period before cardiac signs/symptoms are shown?

A

Mitral stenosis

32
Q

What do you suggest if you find that a patient has a murmur?

A

Get an ECHO evaluation

33
Q

Explain an innocent murmur

A
  • some murmurs are physiologic (benign)
  • may originate from a NORMAL aortic or pulmonic valve
  • most often in children/young adults or conditioned athletes
34
Q

What is usually known as a soft systolic murmur?

A

Innocent murmur

35
Q

If a patients chief complaint is chest pain, what is your primary goal?

A

Decide if it is angina or non-angina chest pain

36
Q

What is angina?

A

Ischemia heart pain

37
Q

What is angina caused by?

A

Imbalance of oxygen supply & demand at myocardium

38
Q

What happen if myocardial demand is not being met by the coronary arteries?

A

Intramyocardial vessels dilate to increase blood supply. This extra volume= coronary flow reserve.

39
Q

What might cause angina?

A

oxygen demand may not be met due to:

  • atherosclerosis
  • failure of intramyocardial vasodilation
40
Q

What are the 2 types of typical angina?

A

Stable (most common)

Unstable (needs urgent evaluation)

41
Q

Describe stable angina.

A

Has a consistent, predictable patterns

  • exercise induced
  • consistent duration (1-5 mins)
  • rest-relieved
  • predictable symptoms
  • usually in the substernal region = Levine’s sign
42
Q

Is angina always felt right over your heart?

A

no- could be felt form umbilicus to eyebrows

43
Q

What is the most common trigger for typical angina?

A

Exercise

44
Q

How is typical angina similar to PAD?

A

It is often exercise induced and relieved with rest

45
Q

For typical angina, what would you expect to find in an examination?

A
  • findings are often normal, so you may want to look for indications of atherosclerosis in other areas
    examples:
  • Decreased LE pulses (PAD)
  • carotid bruits
46
Q

Describe unstable angina.

A

Typically means that angina is worsening due to increased atherosclerosis

  • symptoms occur with increased intensity or frequency
  • ** no longer require exercise to trigger angina
  • plaque > 90&
47
Q

What is prinzmetal’s angina? What’s the trigger?

A

Vasospasm of coronary arteries. The triggers are unknown

48
Q

What might trigger atypical angina?

A
  • cold weather
  • heavy meals
  • exercise
49
Q

Who is most likely to experience atypical angina?

A

elderly
females
diabetics

50
Q

What is atypical angina?

A

Dysfunction or occlusion of the “microvasculature”

51
Q

What are risk factors of atypical angina?

A

Microvascular disease
Diabetes
Hypertension
Collagen vascular diseases

52
Q

Does atypical angina require plaque issues or cholesterol issues?

A

No

53
Q

What % of patients having an MI experience pleuritic pain?

A

14%

54
Q

What % of patients having an MI don’t experience chest pain?

A

33%

55
Q

If a patient having an MI doesn’t fall into the category of having no chest pain, or having pleuritic pain what angina equivalents may they experience?

A
  • Dyspnea
  • Nausea
  • Fatigue
  • Pre-syncope
    (more common in elderly & diabetics)
56
Q

What are some symptoms of a MI?

A
  • sympathetic NS is triggered, therefore, they may be:
  • tachycardic
  • increased BP
  • diaphoresis
    However, physical exam may be relatively normal
57
Q

What does acute coronary syndrome refer to?

A
  • it is a blanket term for unstable angina, MI, or sudden cardiac death
  • death of myocardium can cause pump failure and/or electrical instability

PDX 1 (4 decks)

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