Heart sounds Flashcards

1
Q

Hypertrophic cardiomyopathy (HCM) murmur

A

Crescendo-decrescendo systolic murmur heard best at the left sternal border (functional stenosis);

If you move the stethoscope to the apex you will here a holosystolic blowing murmur due to the functional mitral regurgitation that accompanies the functional stenosis

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2
Q

What increases the intensity of HCM murmurs

A

Anything that decreases preload (i.e. decreases venous return); Valsalva and standing both decrease venous return and thus increase the murmur

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3
Q

Why does decreasing the venous return increase the murmur in HCM?

A

Decreases the ventricular size and decreases the area the blood flows across in systole thus increase the venturi effect and bring the mitral valve leaflet closer to the outflow tract

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4
Q

Heart sounds heard best at the right 2nd intercostal space

A

Aortic stenosis and aortic valve sclerosis; this is the “aortic area”

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5
Q

Heart sounds heard best at the left sternal border

A

Aortic and pulmonary regurgitation, HCM

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6
Q

Heart sounds heard best at the left 2nd intercostal space

A

Pulmonic stenosis; this is the “pulmonic” area

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7
Q

Heart sounds heard best at the left 5th intercostal space at the sternal border

A

Tricuspid regurgitation and stenosis, ASD and VSD; tricuspid area

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8
Q

Heart sounds heard best at the 5th intercostal space at the mid-clavicular line

A

Mitral regurgitation and stenosis; mitral area

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9
Q

Inspiration increases the intensity of what heart sounds

A

Right side; increases venous return to RV

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10
Q

Expiration increases the intensity of what heart sounds

A

Left; increase blood return to LV by “squeezing” blood of the pulmonary circulation

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11
Q

Hand grip increases the intensity of what sounds?

A

MR, AR, VSD and MVP

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12
Q

Hand grip decreases the intensity of what murmurs?

A

HCM, AS (decreases the pressure gradient by increasing systemic resistance)

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13
Q

Valsava decreases intensity of what murmurs?

A

Most murmurs

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14
Q

Valsava increases the intensity of what murmurs

A

MVP, HCM

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15
Q

Rapid squatting decreases the intensity of what murmurs

A

MVP, HCM

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16
Q

Rapid standing increases intensity of what murmurs

A

HCM

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17
Q

Systolic heart sounds

A

AS, PS, MR, TR, VSD

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18
Q

Diastolic heart sounds

A

AR, MR, MS, TS

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19
Q

What indicates the intensity of the MS

A

Interval between S2 and opening snap; earlier the OS the more severe the MS

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20
Q

Why does leaning forward increase AS

A

Brings the aorta valve closer to the chest wall

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21
Q

MVP is the leading risk factor for what?

A

Subacute bacterial endocarditis

22
Q

Holosystolic, high pitched “blowing” murmurs

23
Q

What enhances MR murmurs

A

Anything that increases systemic resistance (hand grip, squatting) or LA return (expiration)

24
Q

What enhances TR murmurs

A

Anything that increases venous return (inspiration)

25
Major causes of MR
Ischemic heart disease, MVP, or LV dilation, rheumatic fever, infective endocarditis
26
Major causes of TR
RV dilatation, rheumatic fever, infective endocarditis
27
Holosystolic, harsh sounding murmur
VSD
28
Where is VSD loudest?
Tricuspid area (left 5th intercostal space at the sternal boarder)
29
Maneuvers that increase VSD
Things that increase systemic resistance (hand grip, sudden squatting)
30
Crescendo-decrescendo systolic murmur with an ejection click
Aortic stenosis
31
Where does the murmur radiate to in AS
Carotids and heart base
32
Weak pulses with a delayed peak are found in what murmur
AS; this is pulsus parvus et tardus
33
Sequelae of AS
SAD; syncope, angina, dyspnea
34
Common causes of AS
Bicuspid aortic valve, age related aortic calcific stenosis
35
Late-systolic murmur with a mid-systolic click
MVP
36
When is MVP loudest
S2; crescendos from the mid-systolic click
37
What can MVP predispose to?
Infective endocarditis
38
Causes of MVP
Myxomatous degeneration (most common), rheumatic fever, chordae rupture
39
Connective tissue diseases that may cause MVP
Ehler Danlos, Marfans
40
MVP is enhanced by what?
Diseases that decrease venous return (Valsava, standing quickly)
41
Immediate high-pitched "blowing" diastolic decrescendo murmur
Aortic regurgitation
42
Bounding pulse and head bobbing indicate what murmur
AR
43
Common causes of AR
Aortic root dilatation, bicuspid aortic valve, endocarditis, rheumatic fever
44
What increase AR murmur
Increased systemic resistance (hand-grip)
45
Tx for AR is what
Vasodilators/afterload reducers (ACE inhibitors, hydralazine)
46
Diastolic murmur with an opening snap, rumbling
MS
47
MS often caused by what
Rheumatic fever
48
Chronic MS can result in what?
LA dilatation
49
What enhances MS murmur
Things that increase LA return (expiration)
50
Continuous machine-like murmur
Most likely PDA; however, it could also be transposition of the great vessels