Heart Sounds/ Murmurs Flashcards
In what murmur can you see head-bobbing, water hammer pulse, or femoral bruits?
aortic regurgitation
What characterizes aortic stenosis?
crescendo-decrescendo murmur
btw S1-S2
Old-SAD
radiates UP to carotids
What does S3 sound like?
Ken-tuckee
blood filling relaxed and empty ventricle
hear right after S2!
What creates the 4th heart sound?
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!
What does the LAD/ anterior interventricular A supply blood to?
Part of AV node
part of His bundle
R bundle branch
anterior fascicle of left bundle branch
What is the first heart sound?
closure of the AV valve –> blood rushing against it
What action decreases aortic stenosis murmors?
increases?
valsalva/standing - decreases
rapid squating - increases
What creates the 3rd heart sound?
blood rushing into the ventricle during the rapid filling phase (AV valves open)
*normal in children, but might not be heard in normal adults
What is the mnemonic to remember the heart assessment points?
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
What murmur is associated w/ connective tissue disorders and marfan’s?
aortic regurgitation
What causes a systolic murmur?
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
What characterizes mitral regurgitation?
“Rheu-mitral”
radiates to axilla
best heard at apex
holosystolic (same loudness throughout) btw S1 and S2
What characterizes mitral stenosis?
the Operating System is MicroSoft
opening snap, rheumatic fever hx
loud, soft, then loud before S1
What is the second heart sound associated with?
closing of aortic and pulmonary valves –> blood backflows and bounces off closed valves
What characterizes a mitral valve prolapse?
midsystolic “click”
associated w/ young women w/ psychiatric history
see the MVP to be the MVP and everything will click
What is a heart murmur caused by?
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
What are the two exceptions to the general rules of preload?
HOCM and MVP
both: increase in preload improves murmur
and increase in afterload improves murmur
What does the Right coronary artery supply blood to?
SA node
AV node
bundle of His
Posterior fascicle of L bundle branch
What characterizes a tricuspid regurgitation?
holosystolic btw S1 and S2
Want to TRI some drugs?
What characterizes aortic regurgitation?
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
What does S4 sound like?
tennessee = atrial filling from venous return
before S1!
What murmurs are associated w/ atrial systole?
tricuspid stenosis
mitral stenosis
What are the general rules for what makes murmurs loud or soft?
RINspiration LEXspiration increasing preload --> louder murmur decreasing preload --> softer murmur increasing afterload --> louder murmur decreasing afterload --> softer murmur
What causes a diastolic murmur?
blood moving back into the aorta or pulmonary artery, caused by regurgitation
blood having a hard time getting into the ventricle due to stenosis
How do you grade heart murmors?
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
What murmurs are associated w/ ventricular systole?
aortic stenosis
pulmonic stenosis
What murmor is associated w/ IV drug use?
tricuspid regurgitation
How does inspiration affect heart sounds?
incr intensity of R heart sounds
increases venous return to RA
How does hand grip affect heart sounds?
this increases afterload
incr intensity of MR, AR, and VSD murmors
decr hypertrophic cariomyopathy and AS murmurs
MVP: later onset of click/murmur
How does valsalva and standing affect heart sounds?
This decreases preload
decr intensity of most murmurs (including AS)
increases intensity of hypertrophic cardiomyopathy murmur
MVP: earlier onset of click/murmur
How does rapid squatting affect murmurs?
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
