Murmur Auscultations and Peri/Endocarditis Flashcards
Systolic murmur heard at 5th interspace (L sternum). High pitched, holosystolic, Blowing. Worse on inspiration
Tricuspid Regurg
Diastolic murmur heard at 5th interspace (L sternum). Low pitched, rumbling, worse on inspiration
Tricuspid stenosis
Systolic murmur heard at 2nd interspace/upper right sternal border. Medium pitch, harsh. Decreased on valsalva, IHG
Increased on squat
Aortic stenosis
Diastolic murmur heard at 2nd interspace, right sternum. High pitched, Blowing, increased with IHG/squat. Decreased with valsalva
Aortic regurgitation
Diastolic murmur heard at 5th interspace, MCL (at the PMI). Low pitched, Rumbling
S1 loud, S2 split, OS heard
Mitral stenosis
Systolic murmur heard at 5th interspace, MCL. Musical quality, Increased click to S2 during Valsalva, increased during IHG.
MVP
Systolic murmur heard at 5th interspace, MCL. Holosystolic, High pitched, Blowing, increased during IHG.
Mitral Regurg
Systolic murmur heard at 2nd interspace, Left sternum. Medium pitched, harsh quality
Pulmonic stenosis
Diastolic murmur heard at 2nd interspace, left sternum. High pitched, blowing
Pulmonic regurg
Systolic murmur, increased (less VR) during valsava, decreased during squat.
HOCM
Holosystolic murmur that is increased with IHG
VSD
What is the best test to order to diagnose valvular disease?
Echo is definitive
12-lead EKG will identify sequelae
24 HOlter for arrhythmias
What botanicals can lower HR in tachycardic patients?
Lycopus, Bryonia, Cactus
Patients with metastatic cancer are likely to develop R/L sided lesions?
R sided lesions
Patients who have gotten radiations are more likely to develop what valvular condition?
Aortic S and/or ARegurg
CXR shows a “water-bottle” heart shape. Dx?
Pericarditis
What labs would you order to Dx Endocarditis if suspected?
Blood cultures, Echo (to find vegetations)
What is the Jones criteria?
Criteria for Rheumatic Fever diagnosis (dt Strep A)
(2 major OR 1 major and 2 minor criteria met = Dx)
Major criteria:
polyarthritis, carditis, subcutaneous nodules, erythema marginatum, Syndehans chorea
Minor criteria:
fever, arthralgia, increased ESR/CRP, leukocytosis, Hx of rheumatic fever/heart disease, ECG shows heart block.
What is the Duke criteria?
Criteria for endocarditis diagnosis:
(2 Major OR 1 Major and 3 Minor OR 5 Minor criteria met = Dx)
Major criteria:
positive blood culture, Echo shows intracardiac oscillating mass/valvular dysfunction
Minor criteria:
predisposing heart condition/ IV drug use Hx, fever, Vascular phenomena (eg. arterial emboli, pulmonary infarcts, mycotic aneurysms, intracranial bleed, conjunctival hemorrhages, Laneway lesions)
Immunologic phenomena (glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor)
Blood culture positive for alternate organisms
Echo cartography shows abnormalities but is not specific for endocarditis
Endocarditis Tx:
Abx, monitoring
Nattokinase, ASA, fish oil, plavix (anticoagulation)
surgical intervention
Pericarditis Tx:
NSAIDs, corticosteroids, pericardiocentesis, pericardectomy (if recurrent)
Bromeliad, proteolytic enzymes, high dose fish oil
high dose crataegus (1 tsp solid extract TID or more)
hydrotherapy…etc
What is the universal botanical cocktail for valvular diseases?
3 Cs: Crataegus, Cactus, Convallaria
What diagnostic testing would indicate Strep infection?
What are some sequelae of Strep infection?
Throat culture (in cases of pharyngitis) ASO (anti-streptolysin O) titer (Group A strep)
Sequelae:
SBE, Rheumatic fever
What are the 4 stages of ECG findings in pericarditis?
- ST elevation in all leads except V1
(ddx MI: would only show regional ST changes) - ST segment WNL, T-wave flattening
- T-wave inversion without Q-wave formation
- ECG normalization
May also note: PR depression, electrical alternans
