Johns- Murmurs

Question 1

Where in the cardiac cycle is an aortic stenotic murmur heard?

Answer 1

Early to mid systole

Question 2

Where is an aortic stenosis murmur heard best?

Answer 2

over the BASE and tends to radiate to the carotids

Question 3

What does an aortic stenosis murmur sound like?

Answer 3

Cresendo then decresendo

Question 4

What might you hear in the light stages of an aortic stenosis murmur?

Answer 4

Decreased systolic pressure

Slow carotid upstroke

Question 5

What can cause aortic stenosis?

Answer 5

1. Degenerative calcification
2. Rheumatic fever
3. Bicuspid valve

Question 6

What represents a critical obstruction in aortic stenosis?

Answer 6

Pressure gradient over 50 mm or 1/3 of normal valve area

Question 7

A pt presents to you with angina, syncope, and dyspnea on exertion …what might they have?

Answer 7

Aortic Stenosis

Question 8

What is the treatment for aortic stenosis?

Answer 8

valve replacement

balloon valvuloplasty in children and adults

Question 9

What is a mitral regurge murmur heard in the cardiac cycle?

Answer 9

Holosystolic

Question 10

Where is a mitral regurge murmur heard best?

Answer 10

Apex and radiates to the axilla

Question 11

What causes mitral regurge?

Answer 11

1. RHD
2. Congenital
3. Acute MI w/ papillary muscle dysfunction
4. Endocarditis
5. Calcification with age

Question 12

What happens in mitral insufficiency?

Answer 12

Decreased forward flow

Question 13

What is the difference between acute and chronic mitral insufficiency?

Answer 13

acute- little enlargement of LA, pulmonary edema

chronic- large left atrium

Question 14

What are symptoms of acute mitral regurge?

Answer 14

1. Pulmonary edema

2. acute shortness of breath

Question 15

What are sxs of chronic mitral regurge?

Answer 15

1. severe fatigue

2. atrial fibrillation

Question 16

What is treatment for mitral regurge?

Answer 16

1. medical tx for CHF, atrial fib.

2. Surgery- pts w/ severe MR who are limited in work/routine household tasks

Question 17

Where is mitral stenosis best heard in the cardiac cycle?

Answer 17

Diastolic murmur

Question 18

Where is mitral stenosis best hear?

Answer 18

At apex w/ pt in left lateral recumbent position

Question 19

What does mitral stenosis sound like?

Answer 19

Low pitched rumble

Opening Snap precedes rumble

Question 20

What causes mitral stenosis?

Answer 20

1. RF
2. Rarely congenital
3. Has decreased incidence since strep treatment.

Question 21

What happens in mitral stenosis?

Answer 21

Valve orifice right ventricle failure

Question 22

What sxs are associated with mitral stenosis?

Answer 22

Dyspnea w/ exertion and cough
hemoptysis
arterial embolism

Question 23

What is the best treatment for mitral stenosis?

Answer 23

1. Antibiotic prophylaxis
2. CHF
3. A. Fib
4. Valve replacemnt if valve area less than 1.0 cm

Question 24

When is aortic insufficiency heard in the cardiac cycle?

Answer 24

High pitched diastolic murmur

Gets louder and longer with increasing severity

Question 25

Where is aortic insufficiency heard best?

Answer 25

At the base

Question 26

When is aortic insufficiency best heard?

Answer 26

When pt is sitting

Question 27

"Water hammer" pulse and an increased pulse pressure are associated with what murmur?

Answer 27

Aortic insufficiency

Question 28

What causes aortic insufficiency?

Answer 28

2/3 are rheumatic | Endocarditis, trauma, congenital

Question 29

What happens in aortic insufficiency?

Answer 29

Increased stroke volume

Question 30

What often precedes sxs associated w/ aortic insuffieciency?

Answer 30

Deterioration of LV function

Question 31

A pt comes in who is uncomfortably aware of their heartbeat when lying down, exertional dyspnea, orthopnea and PND, as well as angina and CHF....what type of murmur do they have?

Answer 31

Aortic insufficiency

Question 32

Why is aortic insufficiency difficult to treat?

Answer 32

1. Pts are asymptomatic until myocardial dysfunction develops. 2. Myocardial dysfunction does not return until after surgery

Question 33

When is a mitral valve prolapse heard in the cardiac cycle?

Answer 33

Mid or late cystolic click that can be followed by a high pitches late systolic murmur

Question 34

Where is a mitral valve prolapse often heard best?

Answer 34

Apex

Question 35

Click-murmur syndrome is another name for...

Answer 35

mitral valve prolapse

Question 36

What causes mitral valve prolapse? What population is it most commonly seen in?

Answer 36

congenital or genetic | F 14-30

Question 37

What is the pathophysiology of mitral valve prolapse?

Answer 37

Myxomatous degeneration of posterior leaflet. Usually benign but it can trigger arrythmias.

Question 38

What is the best treatment for mitral valve prolapse?

Answer 38

Reassurance

Question 39

What cause tricuspid stenosis?

Answer 39

RF--rare here but can commonly be seen in developed countries. Also associated with mitral stenosis.

Question 40

A pt comes in with a giant A wave in the neck, and a diastolic murmur heard best along the lower left sternal border and xiphoid. What do they have?

Answer 40

Tricuspid stenosis

Question 41

A pt comes in with a holosystolic murmur at LLSB and prominent v waves in the neck. What do they have?

Answer 41

Tricuspid regurgitaiton

Question 42

Tricuspid regurge is a sign of what type of heart failure?

Answer 42

Right heart failure Function comes from right ventricular dilation

Question 43

A pt comes in with a midsystolic murmur at the left 2nd and 3rd interspaces. The murmur is preceded by an ejection click. What type of murmur do they have?

Answer 43

Pulmonic stenosis **usually benign in a young person

Question 44

Innocent murmurs are found in what percentage of children?

Answer 44

30-50%

Question 45

A child comes in with a systolic ejection murmur that ends will before S2. It is of grade II intensity and has no thrills and doesn't radiate. What type of murmur do they have?

Answer 45

Innocent murmur