Heart Sounds/ Murmurs Flashcards

1
Q

In what murmur can you see head-bobbing, water hammer pulse, or femoral bruits?

A

aortic regurgitation

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2
Q

What characterizes aortic stenosis?

A

crescendo-decrescendo murmur
btw S1-S2
Old-SAD
radiates UP to carotids

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3
Q

What does S3 sound like?

A

Ken-tuckee
blood filling relaxed and empty ventricle
hear right after S2!

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4
Q

What creates the 4th heart sound?

A

atrial contraction = result of the last little bit of blood being squeezed into the ventricles
normal in children, not generally heard in a normal adult
hear right before S1!

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5
Q

What does the LAD/ anterior interventricular A supply blood to?

A

Part of AV node
part of His bundle
R bundle branch
anterior fascicle of left bundle branch

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6
Q

What is the first heart sound?

A

closure of the AV valve –> blood rushing against it

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7
Q

What action decreases aortic stenosis murmors?

increases?

A

valsalva/standing - decreases

rapid squating - increases

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8
Q

What creates the 3rd heart sound?

A

blood rushing into the ventricle during the rapid filling phase (AV valves open)
*normal in children, but might not be heard in normal adults

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9
Q

What is the mnemonic to remember the heart assessment points?

A
All Physicians Take Money
Aorta = R 2nd intercostal space
Pulmonic area = L 2nd intercostal space
Erb's point = L 3rd intercostal space
Tricuspid = L 4th intercostal space
Mitral = 5th intercostal space, L midclavicular
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10
Q

What murmur is associated w/ connective tissue disorders and marfan’s?

A

aortic regurgitation

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11
Q

What causes a systolic murmur?

A

either blood is moving back into the atria, caused by regurgitation
blood is having a hard time moving in the direction it should be moving in (can’t get into the aorta/pulmonary A

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12
Q

What characterizes mitral regurgitation?

A

“Rheu-mitral”
radiates to axilla
best heard at apex
holosystolic (same loudness throughout) btw S1 and S2

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13
Q

What characterizes mitral stenosis?

A

the Operating System is MicroSoft
opening snap, rheumatic fever hx
loud, soft, then loud before S1

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14
Q

What is the second heart sound associated with?

A

closing of aortic and pulmonary valves –> blood backflows and bounces off closed valves

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15
Q

What characterizes a mitral valve prolapse?

A

midsystolic “click”
associated w/ young women w/ psychiatric history
see the MVP to be the MVP and everything will click

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16
Q

What is a heart murmur caused by?

A

blood moving in a direction it shouldn’t be
or blood having a hard time moving in the direction it should be moving in
can be heard in systole or diastole

17
Q

What are the two exceptions to the general rules of preload?

A

HOCM and MVP
both: increase in preload improves murmur
and increase in afterload improves murmur

18
Q

What does the Right coronary artery supply blood to?

A

SA node
AV node
bundle of His
Posterior fascicle of L bundle branch

19
Q

What characterizes a tricuspid regurgitation?

A

holosystolic btw S1 and S2

Want to TRI some drugs?

20
Q

What characterizes aortic regurgitation?

A

AR thar she blows!
early blowing after S2
seen in connective tissue disorders, marfan’s
can see head-bobbing, water hammer pulse, and femoral bruits

21
Q

What does S4 sound like?

A

tennessee = atrial filling from venous return

before S1!

22
Q

What murmurs are associated w/ atrial systole?

A

tricuspid stenosis

mitral stenosis

23
Q

What are the general rules for what makes murmurs loud or soft?

A
RINspiration
LEXspiration
increasing preload --> louder murmur
decreasing preload --> softer murmur
increasing afterload --> louder murmur
decreasing afterload --> softer murmur
24
Q

What causes a diastolic murmur?

A

blood moving back into the aorta or pulmonary artery, caused by regurgitation
blood having a hard time getting into the ventricle due to stenosis

25
Q

How do you grade heart murmors?

A

score out of 6
1 = soft heart in quiet surroundings
2 = soft heard in noisy surroundings
3 = prominent
4 = loud with a thrill
5 = loud heard w/ edge of steth tilted against chest + thrill
6 = loud heard 5-10 mm from chest + thrill

26
Q

What murmurs are associated w/ ventricular systole?

A

aortic stenosis

pulmonic stenosis

27
Q

What murmor is associated w/ IV drug use?

A

tricuspid regurgitation

28
Q

How does inspiration affect heart sounds?

A

incr intensity of R heart sounds

increases venous return to RA

29
Q

How does hand grip affect heart sounds?

A

this increases afterload
incr intensity of MR, AR, and VSD murmors
decr hypertrophic cariomyopathy and AS murmurs
MVP: later onset of click/murmur

30
Q

How does valsalva and standing affect heart sounds?

A

This decreases preload
decr intensity of most murmurs (including AS)
increases intensity of hypertrophic cardiomyopathy murmur
MVP: earlier onset of click/murmur

31
Q

How does rapid squatting affect murmurs?

A

this increases venous return, preload, and afterload
decr intensity of hypertrophic cardiomyopathy
incr intensity of MR, AR, and VSD
MVP: later onset of click/murmur