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Patho > Murmur 2.0 > Flashcards

Murmur 2.0 Flashcards

1
Q

Early systolic murmurs

A

Mitral regurgitation

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2
Q

Mid systolic murmurs

A

Aortic stenosis
Pulmonic stenosis

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3
Q

Holosystolic murmurs

A

Mitral Regurgitation
Tricuspid Regurgitation
VSD
HCM

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4
Q

Early diastolic murmurs

A

aortic regurgitation

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5
Q

Mid diastolic murmurs

A

Mitral stenosis
tricuspid stenosis

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6
Q

Late systolic murmurs

A

Patent Ductus Arteriosis (PDA) can be continuous

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7
Q

Located at the apex

A

Mitral regurg
Mitral stenosis

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8
Q

Located at the R 2nd intercostal space

A

Aortic stenosis
Aortic regurg

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9
Q

Located at the 4th intercostal space

A

Tricuspid regurg
Tricuspid stenosis

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10
Q

Located at the left second intercostal space

A

pulmonic stenosis
PDA

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11
Q

Located at the 3/4th intercostal space

A

VSD (Ventricular septal defect)

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12
Q

Where does MR, MS, and TS radiate to?

A

axilla

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13
Q

Where does TR radiate to?

A

epigastric

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14
Q

Where does PS and AS radiate to?

A

neck

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15
Q

Where does VSD and PDA radiate to?

A

left clavicle

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16
Q

Where does AR radiate to?

A

apex

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17
Q

What is the quality of MR?

A

blowing/high pitched

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18
Q

What is the quality of AS?

A

harsh, rough

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19
Q

What is the quality of PS?

A

harsh, loud with a thrill

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20
Q

What is the quality of VSD?

A

low pitch but can also be high

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21
Q

What is the quality of HCM?

A

harsh

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22
Q

What is the quality of AR?

A

high, blowing

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23
Q

What is the quality of MS?

A

loud, rumbling

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24
Q

What is the quality of TS?

A

rumbles

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25
Q

What is the quality of PDA?

A

loud with a thrill

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26
Q

Mitral regurg

A
  1. Primary Cause:
    MVP
    Rheumatic
  2. Secondary Cause:
    LV enlargement leading to mitral annular dilatation and displacement of the papillary muscles
  3. A- fib is common
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27
Q

Mitral valve prolapse

A

Abnormal ballooning
Most common with MR

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28
Q

Aortic stenosis

A
  1. Can be with thrill - neck
  2. Syncope and angina
  3. Early systolic click
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29
Q

Tricuspid regurgitation

A
  1. Primary: endocarditis
  2. Secondary: pulm HTN
    Intensity increases with inspiration
    Decrease with valsalva
  3. HF- JVP, ascites, edema
30
Q

Pulmonic stenosis

A

Congenital
Rare
R sided HF

31
Q

VSD

A

Congenital
Any pts tolerate it well into adulthood

32
Q

HCM

A
  1. LVH
  2. Most common cause of cardiac arrest in young athlete
  3. Squatting effect
    Most Murmur becomes more intense when squatting but HCM is opposite
33
Q

Aortic regurg

A
  1. Primary: damages leaflets
    Secondary: dilates the leaflets
  2. Heard better with pt leaning forward
34
Q

Mitral stenosis

A
  1. Opening snap with S2
  2. # 1 cause because of rheumatic HD
  3. A fib, RHF
  4. Murmur does not increase with inspiration
35
Q

Tricuspid stenosis

A
  1. Usually involved with MS and rheumatic heart disease
  2. Increased intensity with inspiration
36
Q

PDA

A
  1. Machine like
  2. Congenital
    Connection from aorta to pulmonary
37
Q

Venous Hum

A

Altered flow in the vein
Eliminate the murmur by pressing on the IJV

38
Q

Friction rub

A

Pericarditis or pericardial effusion

39
Q

Innocent murmur

A

Murmur without any cardiac anatomy

Common in infancy and childhood
May come and go based on hydration/volume status and heart rate
Also referred to as physiologic murmur or functional murmur
Venous hum is considered an innocent murmur

40
Q

Which is consistent with the left sternal border, 5th intercostal space?

A) Erb’s point
B) Mitral area
C) Aortic area
D) Tricuspid area

A

Mitral area

41
Q

The murmur of hypertrophic cardiomyopathy becomes more intense with standing or Valsalva

True
False

A

False

42
Q

Grade the following murmur: loud with a palpable precordial thrill

A) Grade II
B) Grade III
C) Grade IV
D) Grade V

A

Grade IV

43
Q

What is the most common cause of tricuspid regurgitation?

A) Pulmonary artery hypertension
B) Endocarditis
C) Rheumatic heart disease
D) B and C

A

Pulmonary artery hypertension

44
Q

Which of the following is NOT a symptom of aortic stenosis
A) Chest pain
B) Syncope
C) Exertional dyspnea
D) Back pain

A

back pain

45
Q

What is pulmonary HTN?

A
  1. Primary:
    Pulmonary artery hypertension due to vascular remodeling of the arteries themselves
  2. Secondary:
    Pulmonary artery hypertension due to another pathologic process:
    -Pulmonary embolus
    -Lung disease (COPD, pulmonary fibrosis)
    -Left heart failure
46
Q

What are pathologic murmurs?

A

due to abnormal cardiac anatomy or physiology

47
Q

PERICARDITIS

A

Inflammation of the pericardium
Often viral, self limited
Treatment is symptomatic
NSAIDs

48
Q

PERICARDIAL EFFUSION

A

Fluid accumulation in the pericardial sac
Viral
Iatrogenic
Traumatic/hemorrhagic

49
Q

What are continous murmurs?

A
  1. patent ductus arteriosus
  2. venous hum
  3. pericardial friction rub
50
Q

What are the grades for intensity of murmurs?

A

Grade I: very faint
Grade II: soft murmur, readily detectable
Grade III: loud but no palpable thrill
Grade IV: loud with palpable precordial thrill
Grade V: very loud, audible with stethoscope lightly on the chest with a palpable precordial thrill
Grade VI: loudest murmur, audible WITHOUT a stethoscope, + palpable thrill

51
Q

Atrial septal defect

A

diastolic

52
Q

Ventricular septal defect

A

systolic

53
Q

What are the factors that affect turbulence?

A

The size of the orifice of vessel through which the blood flows

The pressure difference (the gradient) across the narrowing

The volume of blood flowing across a site

54
Q

“All Physicians Earn Too Much”

A

A: Aortic area: 2nd right intercostal space

P: Pulmonic area: 2nd left intercostal space

E: Erb’s point (left sternal border): 3rd left intercostal space

T: Tricuspid area: 4th left intercostal space

M: Mitral area (apex): 5th left intercostal space

55
Q

Which is S1?

A

Look for carotid upstroke, which will occur just AFTER S1

56
Q

Systolic murmur

A

starts with or after S1 and terminates with or before S2

57
Q

Early systolic murmur

A

Obscures S1, does not extend to S2

58
Q

Mid systolic murmur

A

begins after S1, ends before S2 (both S1 and S2 easily audible)

59
Q

Holosystolic (pansystolic) murmur

A

obscures both S1 and S2, lasts entire duration

60
Q

Late systolic murmur

A

starts after S1, extends to S2

61
Q

What are systolic murmurs?

A

Mitral regurgitation
Tricuspid regurgitation
Aortic stenosis
Pulmonic stenosis
Ventricular septal defect
Hypertrophic obstructive cardiomyopathy

62
Q

Diastolic Murmurs

A

starts with or after S2 and ends with or just before S1

63
Q

Early diastolic

A

starts with S2 and ends before S1

64
Q

Mid-diastolic

A

starts after S2, terminates before S1

65
Q

Late diastolic

A

starts well after S2, terminates with S1

66
Q

Which diastolic murmur is most common?

A

Aortic regurgitation

67
Q

Radiates to the mid R sternal border

A

PR

68
Q

What is the quality of PR?

A

blowing

69
Q

What is the quality of TR?

A

soft, difficult to hear

70
Q

Pulmonic regurg

A
  1. primary cause: abnormal pulm valve function
    secondary: much more common and almost always due to pulm HTN
  2. wide split S2
  3. severe will cause R sided HF

Patho (16 decks)

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