Heart OSCE Flashcards
MR how does it sound?
Blowing/holosystolic radiating to left axilla
TR how does it sound?
blowing quality/holosystolic
MS how does it sound?
rumbling, low pitched
What is associated w/ PS?
Increases w/ inspiration
What does expiration do to heart sounds?
Left side gets louder, right side gets quieter
Explain how squatting causes MVP and HCM to DECREASE in intensity?
Squatting increases venous return, PVR, SV and BP while standing has the opposite effect
When does TS increase in intensity?
Inspiration
PS how does it sound?
harsh, loud, ejection click radiating into left shoulder
AR what does it sound like?
blowing, decrescendo murmur
Aortic Stenosis where?
2nd/3rd R ICS
Where is PS?
2nd/3rd L ICS
How do you position volume overloaded patients to test for JVP?
Elevate head to 60-90*
What does inspiration do to heart sounds?
Right side gets louder, left side gets quieter
Where is AR?
2nd-4th ICS on LEFT
What is associated w/ TR?
Increases w/ inspiration
What conditions, other than HF, is JVP increased in?
- TS
- Chronic PAH
- SVC obstruction
- Tamponade
- Constrictive pericarditis
What murmur is better heard by leaning forward?
AR
When does TS decrease in intensity?
Expiration & valsalva
What side of stethoscope to use for MS?
BELL
What is associated w/ AS?
delayed pulses (pulsus tardus et parvus)
What side of stethoscope to use for AR?
Diaphragm
What murmur increases INTENSITY w/ valsalva?
HCM
Where is MR?
Prominent @ apex
TR (insufficiency) where?
Lower left sternal border
MS where?
APEX
What murmur is better heard by straining/valsalva?
MR
PR how does it sound?
blowing quality
What murmur is better heard w/ left lateral decubitus position?
MS (and extra heart sounds)
What is associated w/ MR?
Loudness correlates w/ degree of valve insufficiency
What murmur increases DURATION w/ valsalva?
MVP
What is JVP like in COPD?
elevated w/ expiration but collapses on inspiration
How do you position septic/hypovolemic patients to test for JVP?
Lie them flat
AS how does it sound?
harsh quality (crescendo/decrescendo) radiating into suprasternal notch and carotids
How does VSD sound?
Holosystolic murmur @ LLSB
What causes fixed splitting?
ASD
What causes reverse (paradoxical) splitting?
LBBB
AS
CoA
PDA
What causes widened physiological split?
RBBB
PS
VSD
MR
What causes A2 w/ increased intensity?
Systemic HTN
Aortic root dilation
What causes P2 w/ increased intensity?
PAH
Dilated pulmonary a.
ASD
What causes A2 to be diminished or absent?
Calcific AS
What causes P2 to be diminished or absent?
Increased AP diameter (aging)
PS
Where is PDA murmur best heard?
LUSB that is continuous throughout systole/diastole (machine-like) and crescendo/decrescendo
What murmur can be seen in newborns w/ low Apgar score?
TR
Where is CoA murmur heard?
Posterior chest (b/w scapulae)
Where is Still’s murmur heard?
Systolic murmur w/ maximum intensity @ LLSB
(musical)
Tends to be louder in hyperdynamic (anxiety/fever) states
What does ASD sound like?
Rare to have sx, but systolic murmur @ LUSB (fixed/widely split S2)
What is single most common heart lesion?
Bicuspid aortic valve
