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more murmur Flashcards

1
Q

Classic exertional pain, pressure, or discomfort in the chest, shoulder, back, neck, or arm in angina pectoris, seen in 50% of patients with this

A

myocardial infarction

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2
Q

atypical descriptors in myocardial infarction

A

cramping, grinding, pricking (rarely is tooth or jaw pain)

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3
Q

Unstable angina, non-ST elevation MI, and ST elevation infarction

A

clinical syndromes caused by acute MI

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4
Q

Anterior chest pain, tearing or ripping, often radiating into the back or neck is….

A

acute aortic dissection

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5
Q

Only WHAT can be reliably identified at the bedside during sign or symptoms of irregular heart action

A

atrial fibrillation

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6
Q

Sudden dyspnea can be seen in

A

pulmonary embolus, spontaneous pneumothorax, anxiety

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7
Q

IN what heart conditions might you see orthopnea

A

in left ventricular heart failure or mitral stenosis

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8
Q

PND or paroxysmal nocturnal dyspnea can be indicative of

A

left ventricular heart failure or mitral stenosis

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9
Q

Dependent edema appears in what part of the body

A

lowest body parts - feet and lower legs when sitting or sacrum when bedridden (causes may be cardiac, nutritional, or positional)

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10
Q

Periorbital puffiness and tight rings around the eyes are indicative of what

A

nephrotic syndrome

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11
Q

Venous pressure may appear elevated on expiration in this condition

A

obstructive lung disease

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12
Q

Increased pressure of JVP suggests most commonly….

A

R-sided congestive heart failure

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13
Q

An elevated JVP is 98% specific for what?

A

an increased left ventricular end diastolic pressure and low left ventricular ejection fraction

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14
Q

Unilateral distention of the external jugular vein is usually caused by

A

local kinking or obstruction

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15
Q

Causes of decrease carotid pulsations…

A

decreased stroke volume and local factors in the artery such as atehrosclerotic narrowing or occlusion

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16
Q

Pressure on the carotid can cause what?

A

reflex drop in pulse rate or blood pressure

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17
Q

Small, thready, or weak carotid pulsations are found in….

A

cardiogenic shock, bounding pulse in aortic insufficiency

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18
Q

What happens to the carotid pulse wave (or speed of upstroke) in aortic stenosis?

A

Delayed

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19
Q

Variations in carotid pulse amplitude is seen in

A

pulsus alternans, bigeminal pulse (beat-to-beat variation), parodoxical pulse (respiratory variation)

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20
Q

A murmur-like sounds of vascular rather than cardiac origin is called

A

Bruit

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21
Q

A carotid bruit radiating over the neck is a…

A

aortic valve murmur

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22
Q

The prevalence of assymtpomatic carodtid bruits increases with what?

A

Age. Reaching 8% of people over 75 y/o (increased risk of ischemic heart disease and stroke)

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23
Q

Low-pitched extra sounds such as S3, opening snap, diastolic rumble over the Apical Impulse is what?

A

Mitral Stenosis

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24
Q

Soft drescendo diastolic murmur while patient is leaning forward with your diaphragm over the left sternal border is what?

A

Aortic insufficiency (regurg)

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25
Q

S1 is normally louder than S2 at the apex, if it is decreased, it could be

A

first-degree heart block

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26
Q

S2 is normally louder than S1 at the base of the heart. If it is decreased, it could be

A

aortic stenosis

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27
Q

Detection of thrills upon palpation in addition to loud, harsh, or rumbling murmurs may be present in what?

A

aortic stenosis, patent ductus arteriosus, ventricular septal defect. (Less commonly mitral stenosis)

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28
Q

A heart situated on the R-side of the body would be called

A

dextrocardia. You would be sure to check apical impulse on the R-side of the patient

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29
Q

Pregnancy or a high left diaphragm may displace the apical impulse which direction

A

upward and to the Left

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30
Q

Lateral displacement of the apical impulse can be seen in these conditions

A

CHF, cardiomyopathy, ischemic heart disease. (deformities of thorax and mediastinal shift may also cause it)

31
Q

If pt is in the L lateral decubitus position with a diffuse PMI w/diameter >3cm, what does this indicate?

A

Left ventricular enlargement

32
Q

Increase PMI amplitude can reflect?

A

Hyperthyroidism, severe anemia, pressure overload of L ventricle (as in aortic stenosis), or volume overload of the L ventricle (as in mitral regurgitation)

33
Q

A sustained high-amplitude impulse over PMI suggests

A

L ventricular hypertrophy from pressure overload (as in HTN). If such a long duration impulse occurs laterally, consider volume overload

34
Q

A sustatined low-amplitude (hypokinetic) impulse may result from

A

dilated cardiomyopathy

35
Q

A brief middiastolic impulse indicates what?

A

S3

36
Q

An impulse just before the systolic apical beat itself indicates what?

A

S4

37
Q

A marked increase in amplitude w/little or no change in duration occures in what?

A

chronic volume overload of the R ventricle (as in from an atrial septal defect)

38
Q

An impulse w/increased amplitude and duration occurs in what?

A

w/ pressure overload of the R ventricle as in pulmonic stenosis or pulmonary HTN

39
Q

In obstructive pulmonary disease, hyperinflated lung may prevent palpation of what?

A

an enlarged right ventricle in the L parasternal area. The impulse is felt easily, high in the epigastrium where heart sounds are also often heard best

40
Q

The 2nd L interspace overlies what?

A

The pulmonary artery

41
Q

A prominnet pulsation here often accompanies dilatation or increased flow in the pulmonary artery.

A

Pulmonic or L 2nd ICS

42
Q

A palpable S2 over the L 2nd ICS suggests increased pressure in the?

A

pulmonary artery (as in pulmonary HTN)

43
Q

The 2nd R interspace overlies what?

A

Aortic outlfow tract (I realize she won’t ask us this but if you know landmarks = easier to figure out abnormalities)

44
Q

A palpable S2 over the aortic area or R 2nd ICS suggests?

A

systemic HTN; a pulsation here suggests a dilated or aneurysmal aorta

45
Q

What may have a hypokinetic apical impulse that is displaced far to the Left?

A

A markedly dilated failing heart

46
Q

What may make the apical impulse undectable?

A

A large pericardial effusion

47
Q

A L-sided decubitus position accentuates what?

A

S3, S4, mitral murmurs (especially MITRAL STENOSIS)

48
Q

A sitting and leaning forward position accentuates what?

A

aortic murmurs (especially AORTIC REGURGITATION)

49
Q

Expiratory splitting between S2 suggests?

A

Pathology! (It’s normal upon inspiration) could be from delayed closure of the pulmonic valve (pulmonic stenosis or R bundle branch block) in WIDE SPLITTING, or atrial septal defefct and R ventricular failure in FIXED SPLITTING

50
Q

Persistent splitting results from

A

delayed closure of the pulmonic valve or early closure of the aortic valve

51
Q

A systolic click is the most common sound between S1 and S2, heard in?

A

MVP

52
Q

Diastolic murmurs usually indicate what?

A

Valvular heart disease

53
Q

Diastolic murmurs happen between?

A

S2 and S1

54
Q

What type of murmur begins typically arise from blood flow across the semilunar valves?

A

Midsystolic (see pg 384-385 for etiology)

55
Q

What type of murmur often occur with regurgitant flow across the AV valves?

A

Pansystolic (see pg 383)

56
Q

This is the murmur of mitral valve prolapse and is often, not always preceded by a systolic click…

A

A late systolic murmur

57
Q

What type of murmurs accompany regurgitant flow across incompetent semilunar valves?

A

Early diastolic murmurs (think immediately after S2 without a discernible gap)

58
Q

What type of murmurs reflect turbulent flow across the AV valves?

A

middiastolic and presystolic murmurs

59
Q

This presystolic murmur is a crescendo between S2 and S1

A

mitral stenosis

60
Q

This early diastolic murmur is a decrescendo

A

aortic regurgitation

61
Q

This midsystolic murmur is a crescendo-decrescendo pattern

A

aortic stenosis (and innocent flow murmurs)

62
Q

A loud murmur that often radiates up into the neck (esp on the R side)

A

arotic stenosis

63
Q

Emphysematous lungs may do what to a murmur?

A

May diminish the intensity (in thin folks, the degree of turbulence may be louder than an obese person)

64
Q

A medium-pitched, grade 2/6, blowing decresendo diastolic murmur, heard best in the 4th L interspace, with radiation to the apex is what?

A

Aortic Regurgitation

65
Q

A 60 y/o person w/angina, you hear a harsh 3/6 mid-systolic crescendo-descrendo murmur in the R 2nd interspace radiating to the neck is what?

A

Aortic stenosis (or possibly aortic sclerosis, a dilated aorta, or increased flow across a normal valve)

66
Q

If after you hear a murmur 2/6 in the 2nd and 3rd L interspace and you begin to evaluate any splitting, or ejection sounds while the patient is sitting up, but all is normal…you suspect

A

an innocent or functional murmur w/no pathologic significance.

67
Q

This is the only murmur that increases in intensity during the Valsave manuever (strain phase)

A

Hypertrophic cardiomyopathy

68
Q

This murmur decreases intensity during the Valsave maneuver

A

Aortic stenosis

69
Q

Squatting (or release of the Valsava) decreases intensity in

A

Hypertrophic cardiomyopathy

70
Q

Squatting decreases prolapse of this murmur

A

MVP

71
Q

Alternately loud and soft Korotkoff sounds or a sudden doubling of the apparent heart rate as the cuff pressure declines indicates

A

pulsus alternans (almost always indicates L-sided heart failure)

72
Q

A difference between Korotkoff sounds of > 10mmHg indicates

A

a paradoxical pulse and suggests pericardial tampodnade (possible constrictive percarditis but most commonly obstructive airway disease) see p 377

73
Q

If the JVP is >5cm above the sternal angle and HOB is >30 degrees, you find that there are brisk carotid upstrokes, a bruit is heard over the L carotid artery, and the PMI is diffuse + high pitched harsh 2/6 holosystolic murmur best heard at the apex radiating to the axilla, what 2 things can you suspect?

A

Suggests CHF w/volume overload and Mitral Regurgitation

!! (18 decks)

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