Heart Sounds Flashcards
Holosystolic murmur that increases in intensity with inspiration?
Tricupsid regurgitation
What kind of murmur is usually a/w with IE?
Tricuspid regurgitation. Aortic valve can also be involved in IE but tricuspid regurg is more common.
What are the clinical features of aortic regurgitation?
Diastolic decresendo murmur,Widened pulse pressure, “water hammer” pulse (abrupt upstroke followed by rapid collapse of peripheral pulse), LV enlargment. Left lateral decubitus positions brings the enlarged left ventricle closer to the chest wal land causes pounding sensation and increased awareness of heartbeat
Short systolic murmur at cardiac apex that disappears with squatting is most consistent with?
MVP
Describe the MVP murmur
Systolic mumur with single or multiple non-ejection clicks and or mid-late systolic murmurs of mitral regurgitation
Characteristics for aortic stenosis?Where does it classically radiate to? Where is it best heard?
Increased intensity of apical impulse, narrow pulse pressure, typical systolic murmur (at right upper sternal border). Classically radiates to carotids.
What kind of murmur is characteristic of hypertrophic cardiomyopathy and where is it best heard?
Systolic murmur at left sternal border
Venodilators reduce or increase preload?
Reduce preload
Smaller or larger ventricular volume worsens hypertrophic cardiomyopathy?
Smaller volume leads to a higher degree of obstruction and worsens this diastolic dysfunction.
What is the first line of pharmacologic therapy for hypertrophic cardiomyopathy and why?
Beta blockers - they slow down the heart and prolong diastole, leading to more time for the heart to fill. They also have anti-anginal affect. Calcium channel blockers will also have good effect.
Holosystolic murmur at apex
Occurs as a result of mitral annulus enlargement with LV dilatation or papillary muscle displacement due to LV remodeling
How does a pericardial effusion appear on chest x-ray?
Water bottle shaped cardiac silhouette
What are the physical exam findings of pericardial effusion without cardiac tamponade?
Diminished heart sounds on auscultation and difficult to palpate point of maximum impuse (PMI)
What is the clinical presentation (can be) of amyloidosis?
Asymptomatic proteinuria or nephrotic syndrome, restrictive cardiomyopathy, hepatomegaly, peripehral neuropathy/autonomic neuropathy, visible organ enlargmenet macroglossia), bleeding diathesis, and waxy thickening/easy bruising of skin
Cardiac amyloidosis should be suspected in patients with?
Unexplained CHF (predominantly diastolic dysfunction), echo findings of increased ventricular wall thicken with normal left ventricular cavity dimensions (Especially in absence of HTN( and low voltage EKG.
What kind of sound does S3 make and what is it due to?
Kentuck-KY. Ventricular gallop sound shortly after S2. Heard during rapid filling of ventricles in diastole. Caused by blood inflow from left atrium that strikes blood that is already in the left ventricle, causing reverberation of blood between left ventricular walls.
S3 is normal in?
Normal in children, YOUNG ADULTS, pregnancy.
S3 is it a sign of / a/w?
Age > 40, heart failure, restrictive cardiomyopathy, sign of left ventricular failure high-output states
What is the physiology behind S4 heart sound? Where is it heard and in what position?
S4 heart sound can be heard over cardiac apex in left lateral decubitus position. Heard immediately after atrial contraction phase as blood is forced into stiff, non-compliant ventricle. Can be heard in hearts with stiffened ventricles - so it is heard in older patients or in patients with restrictive cardiomyopathies, hypertensive heart diseases, aortic stenosis, and hypertrophic cardiomyopathy from long standing hypertension. Also heard in acute MI
S4 occurs when?
Atrial gallop that is heard just prior to S1, near the end of diastole. Additional diastolic sound. Produces a rhythm that is often referred to as TEN-NES-SEE. With S4 corresponding to the first syllable.
Crescendo-decrescendo systolic murmur along left sternal border without carotid radiation is description of?
Murmur present in HOCM which interventricular septal hypertrophy.
Mitral regurgitation has what kind of murmur?
Holosystolic systolic murmur heard best at apex
What physiological manuevers decrease preload and how does it affect the hypertrophic cardiomyopathy murmur?
Valsalva (straining phase), abrupt standing (from sitting or supine), nitroglycerin administration. Murmur gets louder.
What physiological maneuvers increase afterload?
Sustained handgrip, squatting (from standing position). Murmur gets softer
What physiological maneuvers increases preload?
Squatting (From standing). Passive leg raise. Murmur gets softer.
