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CRAAB 5 > Johns- Murmurs > Flashcards

Johns- Murmurs Flashcards

1
Q

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

A

Early to mid systole

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2
Q

Where is an aortic stenosis murmur heard best?

A

over the BASE and tends to radiate to the carotids

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3
Q

What does an aortic stenosis murmur sound like?

A

Cresendo then decresendo

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4
Q

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

A

Decreased systolic pressure

Slow carotid upstroke

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5
Q

What can cause aortic stenosis?

A
  1. Degenerative calcification
  2. Rheumatic fever
  3. Bicuspid valve
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6
Q

What represents a critical obstruction in aortic stenosis?

A

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

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7
Q

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

A

Aortic Stenosis

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8
Q

What is the treatment for aortic stenosis?

A

valve replacement

balloon valvuloplasty in children and adults

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9
Q

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

A

Holosystolic

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10
Q

Where is a mitral regurge murmur heard best?

A

Apex and radiates to the axilla

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11
Q

What causes mitral regurge?

A
  1. RHD
  2. Congenital
  3. Acute MI w/ papillary muscle dysfunction
  4. Endocarditis
  5. Calcification with age
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12
Q

What happens in mitral insufficiency?

A

Decreased forward flow

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13
Q

What is the difference between acute and chronic mitral insufficiency?

A

acute- little enlargement of LA, pulmonary edema

chronic- large left atrium

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14
Q

What are symptoms of acute mitral regurge?

A
  1. Pulmonary edema

2. acute shortness of breath

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15
Q

What are sxs of chronic mitral regurge?

A
  1. severe fatigue

2. atrial fibrillation

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16
Q

What is treatment for mitral regurge?

A
  1. medical tx for CHF, atrial fib.

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

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17
Q

Where is mitral stenosis best heard in the cardiac cycle?

A

Diastolic murmur

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18
Q

Where is mitral stenosis best hear?

A

At apex w/ pt in left lateral recumbent position

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19
Q

What does mitral stenosis sound like?

A

Low pitched rumble

Opening Snap precedes rumble

20
Q

What causes mitral stenosis?

A
  1. RF
  2. Rarely congenital
  3. Has decreased incidence since strep treatment.
21
Q

What happens in mitral stenosis?

A

Valve orifice right ventricle failure

22
Q

What sxs are associated with mitral stenosis?

A

Dyspnea w/ exertion and cough
hemoptysis
arterial embolism

23
Q

What is the best treatment for mitral stenosis?

A
  1. Antibiotic prophylaxis
  2. CHF
  3. A. Fib
  4. Valve replacemnt if valve area less than 1.0 cm
24
Q

When is aortic insufficiency heard in the cardiac cycle?

A

High pitched diastolic murmur

Gets louder and longer with increasing severity

25
Q

Where is aortic insufficiency heard best?

A

At the base

26
Q

When is aortic insufficiency best heard?

A

When pt is sitting

27
Q

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

A

Aortic insufficiency

28
Q

What causes aortic insufficiency?

A

2/3 are rheumatic

Endocarditis, trauma, congenital

29
Q

What happens in aortic insufficiency?

A

Increased stroke volume

30
Q

What often precedes sxs associated w/ aortic insuffieciency?

A

Deterioration of LV function

31
Q

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?

A

Aortic insufficiency

32
Q

Why is aortic insufficiency difficult to treat?

A
  1. Pts are asymptomatic until myocardial dysfunction develops.
  2. Myocardial dysfunction does not return until after surgery
33
Q

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

A

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

34
Q

Where is a mitral valve prolapse often heard best?

A

Apex

35
Q

Click-murmur syndrome is another name for…

A

mitral valve prolapse

36
Q

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

A

congenital or genetic

F 14-30

37
Q

What is the pathophysiology of mitral valve prolapse?

A

Myxomatous degeneration of posterior leaflet.

Usually benign but it can trigger arrythmias.

38
Q

What is the best treatment for mitral valve prolapse?

A

Reassurance

39
Q

What cause tricuspid stenosis?

A

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

40
Q

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?

A

Tricuspid stenosis

41
Q

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

A

Tricuspid regurgitaiton

42
Q

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

A

Right heart failure

Function comes from right ventricular dilation

43
Q

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?

A

Pulmonic stenosis

**usually benign in a young person

44
Q

Innocent murmurs are found in what percentage of children?

A

30-50%

45
Q

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?

A

Innocent murmur

CRAAB 5 (9 decks)

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