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2nd Semester Final > Heart Sounds II & III Lecture Powerpoint > Flashcards

Heart Sounds II & III Lecture Powerpoint Flashcards

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1
Q

When you hear a murmur, need to order what diagnostic study…

A

…an echocardiogram

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2
Q

Gradation of heart murmurs and what grade is consistent with pathological heart disease

A

1 - very faint, may not be heard in all positions
2 - quiet but heard immediately
3 - moderately loud
(anything below here is pathologic for heart dz)
4 - loud with palpable thrill
5 (systolic only) - loud with thrill may be heard when stethoscope is partially off chest
6 (systolic only) - very loud with thrill may be heard with stethoscope completely off chest

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3
Q

Cooing dove murmur is always associated with…

A

Still’s murmur

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4
Q

Innocent murmurs characteristics (5)

A
  • grad I-III only
  • no clicks
  • brief duration, never solely diastolic
  • echo will be normal
  • no associated pathological findings
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5
Q

Still’s murmur

A

Most common innocent murmur of childhood (2-6 y.o.), grades I-II, due to vibrations of leaflet attachments in kids, midsystolic heard best at left lower sternal border, vibratory like dove cooing, typically worsened with exercise or excitement

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6
Q

Innocent pulmonary systolic murmur

A

In 8-14 y.o, grades I-III, peaks during mid systole and heard best at left upper sternal border, has no associated symptoms, typically worsened with exercise or excitement

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7
Q

Physiologic peripheral pulmonic stenosis (PPS) murmur

A

Due to small relative size of pulmonary artery with acute angle often in newborns or premature, lasts 3-6 months otherwise must re-evaluate, graded I-II heard best at left upper sternal border

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8
Q

Venous hum

A

Most common continuous innocent murmur, due to turbulence of jugular and subclavian venous return where they meet in the superior vena cava, heard best in the infraclavicular region, disappears when supine, with gentle compression of jugular venous return, or turning head to contralateral side (physiologic compression of return)

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9
Q

Aortic stenosis murmur

A

-heard over aortic area midsystolically often diminishing S2, increases when squatting, associated with ejection click, pulsus parvus et tardus

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10
Q

Pulmonic stenosis murmur

A

-Infrequent often part of congenital disorder, heard over pulmonic area systolic murmur often causing wide splitting of S2 (during inspiration), radiates to carotids or back, causes JVD and possible cyanosis

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11
Q

Pulmonic stenosis symptoms (4)

A

Exertional angina, SOB, fatigue, dizziness

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12
Q

Pulmonic stenosis treatment and one complication

A

Percutaneous balloon angioplasty, can result in regurgitation

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13
Q

VSD 2 sequallae

A
  • RV hypertrophy

- pulmonary hypertension

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14
Q

Infants with VSD

A

Have failure to thrive because they are fatigued and have to choose between breathing and eating and thus must be prescribed high caloric density formula

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15
Q

VSD murmur

A

Holosystolic heard best at tricuspid area, causes wide split of S2

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16
Q

VSD treatment options (5)

A
  • If defect is small no treatment needed
  • Endocarditis prophylaxis
  • Increased caloric need
  • Diuretics
  • Usually close on own but might need surgical intervention if large
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17
Q

Atrial septal defect (ASD) definition

A

Congenital disorder caused by spontaneous malformation of the interartrial septum (closure of foramen ovale) from communication between atria resulting in left to right shunt with turbulent blood flow between atria leading to murmur, can be asymptomatic but progresses with age increasing risk of clot formation

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18
Q

Atrial septal defect murmur

A

Avoid valsalva, auscultated over pulmonic area, fixed split S2 in inspiration and expiration,

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19
Q

Atrial septal defect treatment (1)

A

Surgical intervention

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20
Q

Mitral regurgitation Causes (7)

A
  • weakness in mitral valve leaflets
  • damaged chordae tendinae
  • Papillary muscle ischemia
  • annular dilation
  • infectious endocarditis
  • LVH
  • rheumatic heart disease
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21
Q

Mitral regurgitation murmur

A

holosystolic heard at axilla increased with squatting

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22
Q

Most common cause of mitral regurgitation

A

Mitral valve prolapse

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23
Q

Mitral valve prolapse is a ___ murmur heard at the ___

A

mid late systolic murmur (mid systolic non-ejection click occurring after carotid upstroke), apex (mitral area)

24
Q

Carvallo’s sign

A

A pansystolic murmur that increases in intensity upon inspiration, clinical sign of tricuspid regurgitation*** and used to differentiate it from mitral regurg

25
Q

Aortic stenosis sound

A

Early diastolic, heard over aortic area better when leaning forward and decreased with valsalva

26
Q

Ejection click vs opening snap

A

Ejection click occurs during systole (sometime following S1) and opening snap occurs during diastole (following S2)

27
Q

Mid systolic non ejection click

A

A click heard in the middle to end of systole that indicates mitral valve prolapse

28
Q

Holding breath and leaning forward allows for better hearing of these 2 murmurs

A
  • aortic regurgitation

- pericardial friction rub

29
Q

Strain phase of valsalva allows for better hearing of this murmur

A

-HOCM

30
Q

Squatting allows for better hearing of these 2 murmurs

A
  • aortic stenosis

- mitral regurg

31
Q

Left lateral decubitus allows for better hearing of this murmur

A

-mitral stenosis

32
Q

Valsalva mech of action

A
  • Increase in intrathoracic pressure from inspiration collapses Vena cavae, decreasing venous return
  • Decreased stroke volume of left heart results causing reflex tachycardia
  • Upon release increased venous return
  • corresponding increased stroke volume from left heart causes brief spike in blood pressure
  • reflex bradycardia lowers heart rate back to normal
  • blood pressure returns to normal
33
Q

Narrowing of pulse pressure is associated with this condition

A

Aortic stenosis

34
Q

Carcinoid syndrome

A

Signs and symptoms resulting from growth of carcinoids (slow growing, often nonmalignant tumors) that can cause pulmonary and tricuspid valve thickening an endocardial fibrosis (although its rare), most often causes flushing and diarrhea

35
Q

Ventricular septal defect (VSD) definition

A

A left to right shunt due to congenital hole in the intraventricular septum

36
Q

Mitral regurgitation treatment options (4)

A
  • B blocker
  • Diuretics
  • vasodilators
  • surgical intervention
37
Q

Mitral valve prolapse mech of action and populations affected

A
  • most often due to inability of chordae tendinae and papillary muscles to tether leaflets and keep valve closed during all of systole
  • females aged 20-30 most often, men greater than 50 highest risk of complication
38
Q

Mitral valve prolapse symptoms (4) and treatment

A
  • mostly asymptomatic
  • palpitations
  • syncope
  • tingling in hands and feet

-surgical repair in extreme cases

39
Q

Tricuspid regurgitation murmur

A

Holosystolic heard best at the lower left sternal border, increased intensity during inspiration (carvallo’s sign)

40
Q

Tricuspid regurgitation treatment (3)

A
  • anticoagulants
  • antiarrhythmics
  • surgical repair
41
Q

Mitral stenosis murmur

A

Diastolic murmur described as opening snap after S2 heard best in the mitral area

42
Q

Aortic regurgitation murmur

A

Early diastolic murmur heard best in the aortic area

43
Q

Aortic regurgitation symptoms (3)

A
  • palpitations
  • angina
  • left heart failure (can’t lie flat)
44
Q

Water hammer pulse

A

Jerky pulse that is full then collapses because of aortic insufficiency

45
Q

Traube’s sign

A

Sharp sound over the femoral artery due to collapse of the arteries due to aortic insufficiency

46
Q

Aortic regurgitation treatment options (3) and one to avoid

A
  • vasodilators, ACEI, nifidepine

- Avoid B blockers

47
Q

Most casees of mitral valve stenosis are caused by…

A

….rheumatic fever

48
Q

Mitral stenosis murmur

A

Quiet diastolic murmur with opening snap after S2, heard best at apex and left lateral decubitus or axilla

49
Q

Mitral stenosis symptoms (3)

A
  • undiagnosed for years
  • exercise intolerance
  • hemoptysis
50
Q

Mitral facies

A

Pink or purple patches on cheek due to vasoconstriction because of severe mitral stenosis decreasing perfusion

51
Q

Mitral stenosis treatment options (4)

A
  • B blockers
  • diuretics
  • balloon valvuloplasty
  • valve replacement
52
Q

Tricuspid stenosis common causes (3)

A
  • co-occurs with other disease
  • rheumatic fever
  • congenital disease
53
Q

Tricuspid stenosis symptoms (3)

A
  • ascites
  • hepatomegaly
  • peripheral edema
54
Q

Tricuspid stenosis murmur

A

opening snap heard best along mid left sternal border augmented by carvallo’s sign

55
Q

Pulmonic regurgitation

A

90% of population has it, most common cause of severe is pulmonary hypertension

2nd Semester Final (207 decks)

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