Module 8/9 - Heart Sounds and Murmurs Flashcards
auscultating sounds
APTM
systole
ejecting blood out
SAPO
systolic aortic pulmonic open
systolic mitral tricuspid shut
diastole
DAPS
diastole aortic pulmonic shut
diastole aortic pulmonic open
S3 *
usually means that ventricular compliance is subnormal
STRONG INDICATOR OF EARLY HEART FAILURE
- more likely heard with inspiration after exercise, tachy, elevation of legs
- S3 in child/young adult pathophysiologic and disappears when standing
- best heard with bell at apex in LLD position
S4 *
- called an atrial gallop (heard last third of diastole, just prior to S1)
- almost always abnormal
- due to blood rushing into ventricle with decreased compliance
-Conditions: LVH (HTN, AS), CHD (ischemia or infarction) - best heard with bell at apex in LLD position
Blowing Quality*
MR, TR, AI, VSD
diaphragm
high pitch
Harsh/Rough Quality *
AS, PR, ASD
diaphragm or bell
medium pitch
Rumble Quality *
MS
bell
low pitch
MR physical exam *
HOLOSYSTOLIC MURMUR THAT RADIATES FROM APEX TO AXILLA
- apex laterally displaced
- S2 may be split
- louder with LLD or hand grip
EKG changes:
- AFib
CXR changes:
- LA enlargement
- LVH
- CHF
AS physical exam *
- intensity does not predict severity
- thrill does not predict severity
- crescendo pattern
- RADIATES TO CAROTIDS OR TOWARDS THE NECK
- displaced PMI with heave
- S3 with LV failure
MS physical exam *
- small volume pulse
Ausculatate: LLD
- S1 is accentuated + snapping
- opening snap after AV closure
- low pitch diastolic RUMBLE at apex
Drugs in the class of HMG-CoA reductase inhibitors can cause which of the following complications (particularly if combined with fibric acid derivatives)?
Myositis and rhabdo are toxic affects of HMG-CoA inhibitors (statin)
note: one does not generally combine statins with fibrates because of the side effects get worse when they are combined
63yo female with history of DM presents for BP follow up. Her last two visits her BP was 150/92 and 152/96. Today her BP is 156/92. Recent blood work shows Na of 140, K 4.2, BUN 23, Cr 1.1
which of the following is the most appropriate initial medication choice
lisinopril
ACE should be a part of the initial treatment of HTN in DM bc of beneficial side effects in DM neuropathy. Diuretic should be added if ineffective
74yo diagnosed with PNA. PA should ensure the patient is not on which of the following before starting therapy with clarithromycin
simvastatin
statins interact with macrolides and may cause QT prolongation, myopathy and rhabdo
Which of the following antihypertensive agents is MOST apt to increase plasma LDL with long term use
THIAZIDE DIURETICS
elevated LDL/HDL
BB (except labetalol, pindolol)
Which of the following population groups represent the greatest risk for developing primary HTN
black non hispanic
68yo female in for annual visit. PMHx significant for 40pack year cig smoking. Takes no medication and no hosp/surg. Fam Hx reveals mother is living age 87 in good health, father died 45yo MVA. Two siblings alive and well.
How many identifiable risk factors for cardiovascular heart disease exist?
2
age and cig smoking
Eliciting a history from a patient presenting with dyspnea due to early heart failure the severity of dyspnea should be quantified by
amount of activity that precipitates it
non HDL level
TC - HDL
46yo female being evaluated for a new onset HTN that was discovered on a screening. no meds, PE unremarkable. Labs show hypokalemia.
Most likely diagnosis of patient
primary aldosteronism
primary aldosteronism has an increased aldosterone secretion, which causes the retention of sodium and the loss of potassium.
Pt receiving simvastatin 80mg/day for past 6mo. 2 weeks ago he was diagnosed with HTN and was started on verapamil 240mg/day. Patient in clinic today with complaints of aches in arms and legs. What lab should be tested
CK
