Murmur 2.0 Flashcards
1
Q
Early systolic murmurs
A
Mitral regurgitation
2
Q
Mid systolic murmurs
A
Aortic stenosis
Pulmonic stenosis
3
Q
Holosystolic murmurs
A
Mitral Regurgitation
Tricuspid Regurgitation
VSD
HCM
4
Q
Early diastolic murmurs
A
aortic regurgitation
5
Q
Mid diastolic murmurs
A
Mitral stenosis
tricuspid stenosis
6
Q
Late systolic murmurs
A
Patent Ductus Arteriosis (PDA) can be continuous
7
Q
Located at the apex
A
Mitral regurg
Mitral stenosis
8
Q
Located at the R 2nd intercostal space
A
Aortic stenosis
Aortic regurg
9
Q
Located at the 4th intercostal space
A
Tricuspid regurg
Tricuspid stenosis
10
Q
Located at the left second intercostal space
A
pulmonic stenosis
PDA
11
Q
Located at the 3/4th intercostal space
A
VSD (Ventricular septal defect)
12
Q
Where does MR, MS, and TS radiate to?
A
axilla
13
Q
Where does TR radiate to?
A
epigastric
14
Q
Where does PS and AS radiate to?
A
neck
15
Q
Where does VSD and PDA radiate to?
A
left clavicle
16
Q
Where does AR radiate to?
A
apex
17
Q
What is the quality of MR?
A
blowing/high pitched
18
Q
What is the quality of AS?
A
harsh, rough
19
Q
What is the quality of PS?
A
harsh, loud with a thrill
20
Q
What is the quality of VSD?
A
low pitch but can also be high
21
Q
What is the quality of HCM?
A
harsh
22
Q
What is the quality of AR?
A
high, blowing
23
Q
What is the quality of MS?
A
loud, rumbling
24
Q
What is the quality of TS?
A
rumbles
25
What is the quality of PDA?
loud with a thrill
26
Mitral regurg
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
27
Mitral valve prolapse
Abnormal ballooning
Most common with MR
28
Aortic stenosis
1. Can be with thrill - neck
2. Syncope and angina
3. Early systolic click
29
Tricuspid regurgitation
1. Primary: endocarditis
2. Secondary: pulm HTN
Intensity increases with inspiration
Decrease with valsalva
3. HF- JVP, ascites, edema
30
Pulmonic stenosis
Congenital
Rare
R sided HF
31
VSD
Congenital
Any pts tolerate it well into adulthood
32
HCM
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
Aortic regurg
1. Primary: damages leaflets
Secondary: dilates the leaflets
2. Heard better with pt leaning forward
34
Mitral stenosis
1. Opening snap with S2
2. #1 cause because of rheumatic HD
3. A fib, RHF
4. Murmur does not increase with inspiration
35
Tricuspid stenosis
1. Usually involved with MS and rheumatic heart disease
2. Increased intensity with inspiration
36
PDA
1. Machine like
2. Congenital
Connection from aorta to pulmonary
37
Venous Hum
Altered flow in the vein
Eliminate the murmur by pressing on the IJV
38
Friction rub
Pericarditis or pericardial effusion
39
Innocent murmur
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
Which is consistent with the left sternal border, 5th intercostal space?
A) Erb’s point
B) Mitral area
C) Aortic area
D) Tricuspid area
Mitral area
41
The murmur of hypertrophic cardiomyopathy becomes more intense with standing or Valsalva
True
False
False
42
Grade the following murmur: loud with a palpable precordial thrill
A) Grade II
B) Grade III
C) Grade IV
D) Grade V
Grade IV
43
What is the most common cause of tricuspid regurgitation?
A) Pulmonary artery hypertension
B) Endocarditis
C) Rheumatic heart disease
D) B and C
Pulmonary artery hypertension
44
Which of the following is NOT a symptom of aortic stenosis
A) Chest pain
B) Syncope
C) Exertional dyspnea
D) Back pain
back pain
45
What is pulmonary HTN?
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
What are pathologic murmurs?
due to abnormal cardiac anatomy or physiology
47
PERICARDITIS
Inflammation of the pericardium
Often viral, self limited
Treatment is symptomatic
NSAIDs
48
PERICARDIAL EFFUSION
Fluid accumulation in the pericardial sac
Viral
Iatrogenic
Traumatic/hemorrhagic
49
What are continous murmurs?
1. patent ductus arteriosus
2. venous hum
3. pericardial friction rub
50
What are the grades for intensity of murmurs?
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
Atrial septal defect
diastolic
52
Ventricular septal defect
systolic
53
What are the factors that affect turbulence?
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
“All Physicians Earn Too Much"
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
Which is S1?
Look for carotid upstroke, which will occur just *AFTER* S1
56
Systolic murmur
starts with or after S1 and terminates with or before S2
57
Early systolic murmur
Obscures S1, does not extend to S2
58
Mid systolic murmur
begins after S1, ends before S2 (both S1 and S2 easily audible)
59
Holosystolic (pansystolic) murmur
obscures both S1 and S2, lasts entire duration
60
Late systolic murmur
starts after S1, extends to S2
61
What are systolic murmurs?
Mitral regurgitation
Tricuspid regurgitation
Aortic stenosis
Pulmonic stenosis
Ventricular septal defect
Hypertrophic obstructive cardiomyopathy
62
Diastolic Murmurs
starts with or after S2 and ends with or just before S1
63
Early diastolic
starts with S2 and ends before S1
64
Mid-diastolic
starts after S2, terminates before S1
65
Late diastolic
starts well after S2, terminates with S1
66
Which diastolic murmur is most common?
Aortic regurgitation
67
Radiates to the mid R sternal border
PR
68
What is the quality of PR?
blowing
69
What is the quality of TR?
soft, difficult to hear
70
Pulmonic regurg
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
