murmers

Question 1

Aids: Usually decreasing or disappears on sitting

Answer 1

Innocent Murmurs

Question 2

result from turbulent blood flow, probably generated by ventricular ejection of blood into the aorta from the left and occasionally the right ventricle.

Answer 2

Innocent Murmur

Question 3

Very Common in children and young adults-may also be heard in older people. There is not lying cardiovascular disease

Answer 3

innocent murmurs

Question 4

similar to innocent murmurs, possible signs of a likely cause, turbulence due to a temporary increase in blood flow in predisposing conditions such as anemia, pregnancy, fever, and hyperthyroidism

Answer 4

Physiologic Murmurs

Question 5

the most common kind of heart murmur

Answer 5

midsystolic click

Question 6

three types of midsystolic clicks

Answer 6

innocent - without detectable physiologic or structural abnormality

Question 7

midsystolic murmurs tend to peak _____ and usually stop _______

Answer 7

near mid-systole, usually stop before S2

Question 8

Aids: heard best with the patient sitting and leaning forward

Answer 8

Aortic Stenosis

Question 9

A2 decreases as this worsens. A2 may be delayed and merge with P2 _ single S1 on expiration or paradocixcal S2 split. Carotid upstroke may be delayed with slow rise and small amplitued. Hypertrophied left ventricle may _ sustained apical impulse and an S4 from decreased compliance

Answer 9

…

Question 10

Aids: Decreases with squatting, increases with straining down from Valsava and standing

Answer 10

Hypertrophic Cardiomyopathy

Question 11

associated with unusually rapid ejection of blood from the left ventricle during systole. Outflow tract obstruction of flow may coexist. Accompanying distortion of the mitral valve may cause mitral reguritation

Answer 11

massive ventricular hypertrophy

Question 12

Quality: often harsh

Answer 12

Pulmonic Stenosis

Question 13

In severe pulmonic stenosis ____ is widely split, and ____ is diminished or inaudible. An early pulmonic ejection sound is common. May hear a right sided ____. Right ventricular impulse often increased in amplitude and sustained

Answer 13

S2, P2, S4

Question 14

______ impairs flow across the valve, increasing right ventricular afterload. Congenital and normally found in children.

Answer 14

Pulmonic valve stenosis

Question 15

In an ______, the systolic murmur from pathologically increased flow across the pulmonic valve may mimic pulmonic stenosis

Answer 15

atrial septal defect

Question 16

Diastolic Murmurs, two types

Answer 16

Aortic regurgitation and mitral stenosis

Question 17

Aids: The murmur is heard best with the patient sitting, leaning forward, with breath held after exhalation

Answer 17

Aortic Regurgitation

Question 18

An ejection sound may be present. An S3 or S4, if present, suggusts sever regurgitation

Answer 18

Aortic reguritation

Question 19

Progressive changes in the apical impulse for Aortic Regurgitation include:

Answer 19

increased amplitude, displacement laterally and downward, widened diameter, and increased duration

Question 20

For Aortic Regurgitation, the pulse pressure ______ and the arterial pulses are ______. A midsystolic flow murmur or an Austin Flint murmur suggests large regurgitant flow

Answer 20

Increases,

Question 21

(Diastolic / Systolic) murmurs almost always indicate heart disease.

Answer 21

Diastolic

Question 22

_______ murmurs signify regurgitant flow through an incompetent semilunar valve, more commonly, the aortic

Answer 22

Early descresendo diastolic

Question 23

____ mumurs in mid or late _____ suggest stenosis of an AV valve, usually the mitral

Answer 23

Rumbling diastolic, diastolic

Question 24

Mechanism of aortic reguritation

Answer 24

The leaflets of the aortic valve fail to close completely during diastole, and blood reguritates from the aorta back into the left ventricle. Volume overload on the left ventricle resules.

Question 25

Two other murmurs associatied with Aortic Regurgitation

Answer 25

mid systolic murmur from the resulting increased forward flow across the aortic valve and a mitral diastolic (Austin Flint) attributed to diastolic impingement of the regurgitant flow on the anterior leflet of the mitral valve

Question 26

Aids: placing the bell exactly on the apical impulse turning the patient into a LLD position and mild exercise, better in exhalation

Answer 26

Mitral Stenosis

Question 27

S1 is accentuated and may be palpable at the apex. An opening snap often follows S2 and initiates the murmur

Answer 27

Mitral Stenosis

Question 28

If pulmonary hypertension develops, P2 is acentuated, and the right ventricular impuls becomes palpable.

Answer 28

Mitral Stenosis

Question 29

Mitral regurgitation and aortic valve disease may be associated with

Answer 29

Mitral Stenosis

Question 30

When the leaflets of the mitral valve thicken, stiffen, and become distorted from the effects of rheumatic fever the …

Answer 30

mitral valve fails to open sufficiently in diastole

Question 31

two components of mitral stenosis murmur

Answer 31

middiastolic (during rapid ventricular filling)

Question 32

three examples of cardiovascular sounds with both systolic and diastolic components

Answer 32

venous hum, pericardial friction rub, patent ductus arteriosus

Question 33

a benign sound produced by turbulance of blood in the jugular veins

Answer 33

venous hum

Question 34

produced by inflammation of the pericardial sac

Answer 34

pericardial friction rub

Question 35

a congenital abnormality in which an open channel persists between the aorta and pulmonary artery

Answer 35

patent ductus arteriosus

Question 36

____ mumurs begin in systole and extend through S2 into all or part of diastole

Answer 36

continuous

Question 37

Pitch: low (better heard with bell)

Answer 37

Venous hum

Question 38

Pitch: High (heard better with the diaphram)

Answer 38

Pericardial Friction Rub

Question 39

Pitch: Medium

Answer 39

Patent Ductus Arteriosus