Heart Murmurs & Valve Disease (Exam 2) Flashcards

1
Q

Define a grade 1 murmur.

A

very faint

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2
Q

Define a grade 2 murmur.

A

quiet but heard immediately

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3
Q

Define a grade 3 murmur.

A

moderately loud

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4
Q

Define a grade 4 murmur.

A

loud

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5
Q

Define a grade 5 murmur.

A

heard with stethoscope partly off the chest

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6
Q

Define a grade 6 murmur.

A

no stethoscope needed

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7
Q

What grade of murmurs are thrills associated?

A

Grades 4-6

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8
Q

What murmur(s) does a standing heart sound auscultation accentuate? Soften?

A

may accentuate murmurs associated with mitral valve prolapseor hypertrophic cardiomyopathy. will make murmur of aortic stenosis softer.

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9
Q

What does the squatting or valsalva ausculatation do in regards to murmurs?

A

accentuates murmur of aortic stenosis. will decrease intensity of mitral valve prolapse and hypertrophic cardiomyopathy.

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10
Q

What does a leaning forward heart sound ausculation do in terms of murmurs.

A

can be done to more clearly assess aortic and pulmonic murmurs.

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11
Q

Describe in relationship to systole and diastole aortic stenosis.

A

Flow across an abnormal SL valve or narrowed ventricular outflow tract. It is a midsystolic murmur.

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12
Q

What are the causes of aortic stenosis?

A
degnerative (age>65)
bicuspid valve in the young
rheumatic
atherosclerosis
rare (irradiation, collagen, vascular disease)
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13
Q

What are the symptoms of aortic stenosis?

A

angina-35% - half will die in 5 years
syncope-15% -half will die in 3 years
congestive heart failure-50% -half will dies in 2 years
most are asymptomatic, but once symptoms develop morbidity increases rapidly.

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14
Q

What is the treatment for aortic stenosis in asymptomatic patients?

A

no competititve athletics

mild to moderate disease, need an echo every 2-5 years

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15
Q

What is the treatment for aortic stenosis in symptomatic patients?

A

valve replacement for severe disease, if good surgical risk.
aortic stenosis with symptoms is lethal.

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16
Q

What are the causes of mitral valve regurgitaion/insufficiency?

A

Primary: leaflet, annular, or chordae/papillary muscle abnormalities
secondary: left ventricle or endocardial cushion defect, usually associated with ischemic heart disease-IHD or mitral valve proplapse or infectious endocarditis.

17
Q

What are the symptoms of Mitral Valve Regurgitation/insufficiency?

A
frequently no symptoms
exercise intolerance
palpations long beore HF symptoms begin
ischemic heart symptoms-angina
in severe MR, high left atrial pressure cause dyspnea
as left atria enlarges Afib is common
18
Q

What is the Causes of Mitral stenosis?

A

rheumatic fever and RHD

19
Q

What are the symptoms of mitral stenosis?

A
  • subtle and slow
  • significant mitral stenosis is found in pt with little or no symptoms and very few will have a clear hx of rheumatic fever
  • exercise intolerance
  • palpitations as MS progresses
  • congestive heart failure
  • hoarseness develops as left atrium impinges on the recurrent laryngeal nerve
  • A fib develops in elderly
20
Q

What is the management of mitral stenosis?

A
  • yearly echo
  • negative chronotropes (beta blcoker or ca+ channel blockers to decrease left atrial pressure)
  • Surgical: balloon valvuloplasty for early disease and valve replacement for severe disease
  • therapy for Afib
21
Q

What are the causes of aortic regurgitation/insufficiency?

A
  • Acute: chest traum or endocarditis
  • Mild: bicuspid valve with severe HTN
  • Severe/chronic: degeneration of valve, bicuspid valve, RHD (with mitral disease), trauma and infective endocarditis
  • Rare causes: connective tissure disorder or collagen vascular disorder
22
Q

What are the symptoms of aortic regurgitation/insufficiency?

A
  • exercise intolerance
  • dyspnea, othopnea
  • congestive heart failure
  • angina in only about 5%
  • bounding periperal pulse
23
Q

Describe what you would hear for aortic regurgitaion/insufficiency.

A
  • Best heard in the 2nd or 3rd ICS at the left sternal edge
  • high pitched, decrescendo, early diastolic
  • blowing quality=>may be mistaken for breathing sound
  • radiation: to the sternal border
24
Q

What are the complications of mitral stenosis?

A
  • as it progresses, left atrial enlargement occurs which can lead to mural thrombi, especially with A fib
  • heart rate is critical in MS as HR increases, less time for diastolic ventricular filling, with leads to increased left atrial pressure which ends with pulmonary hypertension
25
Q

Describe what you would hear in aortic stenosis.

A
  • classic crescendo-decrescendo (diamond) shaped murmur
  • loudest in aortic area; radiates along the carotid arteries
  • A2 decreases as the stenosis worsens
26
Q

Describe what you would hear in mitral valve regurgitaion/insufficiency.

A
  • pansystolic murmur
  • loudest at the left ventricular apex
  • radiation reflects the direction of the regurgitant jet: to the axilla and back (flail anterior leaflet) to the base of the heart (flail posterior leaflet.
  • usually associated with a systolic thrill, a soft S3
27
Q

Describe what you would hear in mitral stenosis.

A
  • mid-diastolic murmur due to atrial contraction & rapid ventricular filling
  • low-pitched and best heard over the apex (w/the bell)
  • little or no radiation
28
Q

How does an aortic stenosis murmur fall in realtion to systole and diastole?

A

midsystolic-immediaely after s1 but stops halfway and doesn’t carry to s2

29
Q

How does an aortic regurgitation/insufficiency murmur fall in relation to systole and diastole?

A

early diastolic murmur

30
Q

How does a mitral stenosis murmur fall in relation to systole and diastole?

A

occurs in mid-diastole across AV valve

31
Q

How does a mitral valve regurgitaion/insufficiency murmur fall in relation to systole and diastole?

A

usually is associated with a systolic thrill, a soft s3. pansystolic murmur

32
Q

Define systole in terms of atrial and ventricular filling or contraction.

A

ventricular contraction, atrial filling

33
Q

Define diastole in terms of atrial and ventricular filling or contraction

A

atrial contraction, ventricular filling