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PANRE 2019 > Murmur Power review > Flashcards

Murmur Power review Flashcards

1
Q

Tricuspid regurgitation

A

holosystolic murmur which is best heard at the left lower sternal border (4th interspace) with radiation to the left upper sternal border. Murmur will increase with inspiration due to increased right-sided venous return during inspiration

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2
Q

Tricuspid valve location

A

Between the R Atria and R ventricle

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3
Q

Aortic Stenosis

A

Harsh crescendo-decrescendo mid-systolic ejection murmur.

**Very commonly radiates to R neck. If you don’t hear radiation- make a 2nd guess on diagnosis

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4
Q

Aortic stenosis is best heard

A

2nd R interspace. Pt is sitting and leaning forward

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5
Q

Aortic valve location

A

Between the L ventricle leading to Aortic arch

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6
Q

S1 sound (beginning of systole) What valves close

A

Mitral and tricuspid valves close

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7
Q

S2 sound (end of systole) What valves close

A

aortic and pulmonary valves closing

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8
Q

IMPT Avoid what pharmacologic with outflow obstruction problems such as Aortic Stenosis

A

Systemic vasodilators such as Nitrates are not recommended (risk of SEVERE hypotension)

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9
Q

Aortic stenosis pt presentation

A
  1. middle aged 25% are 65 years of age
  2. external dyspnea
  3. syncope
  4. CHF
  5. Atherosclerosis
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10
Q

Aortic stenosis

A

Most common valvular heart disease in the US

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11
Q

Treatment for angina for aortic stenosis pts

A
  1. Beta blockers

2. Calcium channel blockers

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12
Q

Aortic valve is typically what kind of valve

A

Tricuspid valve

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13
Q

Treatment options for aortic stenosis

A
  1. Prosthetic valve (lasts longer but have to be on lifelong anticoagulation)
  2. Pericardial and porcine valves- do not require anticoagulation but have shorter life span.
  3. Ross procedure- replacement of aortic valve with own pulmonary valve and then replace pulmonary valve.
  4. Balloon valvuloplasty - not effective long term
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14
Q

Mitral valve regurgitation murmur sound

A

pan systolic (holo systolic) blowing murmur radiating to the axilla.

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15
Q

Mitral valve regurgitation is best heard

A

L 5th interspace at the Apex. Left lateral decubitus may amplify murmur.

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16
Q

When is Mitral valve regurgitation decreased and increased

A
  1. Decreased with valsalva or standing

2. Increased with hand grip or squatting

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17
Q

May be heard in Mitral regurgitation

A
  1. Low S3 (indicating heart failure)
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18
Q

Mitral valve patient characteristics

A

Thin Female with mitral valve prolopse.

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19
Q

Mitral valve prolapse is the most common cause of

A

Mitral regurgitation

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20
Q

PE findings mitral valve regurgitation

A
  1. Thin Female
  2. exertional dyspnea
  3. orthopnea
  4. Paroxysmal nocturnal dyspnea 2/2 pulmonary congestion
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21
Q

What happens with mitral regurgitation (ventricle visualization)

A

When the L ventricle contracts, blood leaks back into the L atrium (causing backup into the lungs)

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22
Q

Mitral valve regurgitation how does it affect preload and ejection fraction

A
  1. Causes an increase in preload and an increase in ejection fraction (early stages).
  2. Long term. Enlarged left ventricle and decreased ejection fraction.
  3. Eventually leads to pulmonary congestion.
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23
Q

Causes of mitral regurgitation

A
  1. Congenital
  2. Degenerative mitral valve disease
  3. Thin females with mitral valve prolapse
  4. Rheumatic heart disease
  5. Trauma to mitral valve
  6. MI
  7. Ruptured chordae tendinae (MI or endocarditis most likely)
  8. Endocarditis (regurge can also put pt at increased risk for endocarditis)
  9. Cardiomyopathy
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24
Q

Mitral valve prolapse sound

A

Mid-systolic click

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25
Q

Mitral regurgitation carotid exam

A

Brisk carotid upstroke

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26
Q

Mitral regurgitation lung ascultation

A

rales 2/2 pulmonary congestion

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27
Q

Mitral regurgitation EKG findings

A
  1. Atrial fibrillation

2. L ventricular hypertrophy

28
Q

Diagnosis mitral regurgitation

A
  1. pansystolic blowing murmur at the Apex L 7th interspace radiating to Axilla
  2. Echo with doppler shows severity of regurge and bloodflow
  3. cardiac cath may be used for further assessment
29
Q

Treatment mitral regurgitation

A
  1. Atrial fibrillation- cardioversion, warfarin
  2. Pulmonary congestion- diuretics, vasodilators
  3. Surgery - valve repair or valve replacement
30
Q

Tricuspid regurgitation is this a systolic or diastolic murmur

A

holo SYSTOLIC murmur, L 4th interspace

31
Q

Aortic regurgitation (insufficiency) murmur sound

A

Early diastolic decrescendo in 2nd to 4th Left interspace. Best heard with pt sitting and leaning forward

32
Q

What helps increase the sound in aortic regurgitation

A

Isometric exercise will increase systemic vascular resistance and INCREASE the sound of the murmur.

33
Q

How does aortic regurgitation affect arterial pulse pressure

A

You will hear a high arterial pulse pressure with a quick drop in pressure during diastole

34
Q

Findings in labs and studies with aortic regurgitation

A

CXR: L ventricular hypertrophy
ECG: L ventricular hypertrophy
Echo with doppler is diagnostic
Cardiac cath may also be used

35
Q

Treatment with aortic regurgitation

A
  1. Blood pressure control on decreasing afterload

2. Valve replacement

36
Q

Aortic regurgitation pathophysiology

A

Stroke volume and systolic blood pressure are increased. The diastolic blood pressure decreases leading to a wind pulse pressure which eventually leads to myocardial ischemia - LV hypertrophy

37
Q

What is cardiac preload

A

The preload is the amount of stretch or pressure left in the left ventricle at the end of diastole—when the heart is the most relaxed. It is also referred to as the left ventricular end-diastolic pressure or LVEDP. The greater the preload, the more pressure is available for the next cardiac contraction.

38
Q

What is cardiac afterload

A

The afterload is the amount of vascular resistance that must be overcome by the left ventricle to allow blood to flow out of the heart. It is also referred to as the systemic vascular resistance or SVR. The greater the afterload, the harder the heart has to work to push blood through the systemic vasculature.

39
Q

What medications reduce afterload?

A

Low doses will reduce the preload, while high doses will mildly reduce the afterload. Furosemide (Lasix) and other loop diuretics will decrease the preload by decreasing the total blood volume. These drugs do not act on the heart but cause renal diuresis within an hour of intravenous administration. ACE-I (blocks the formation of certain chemicals that act on the body to maintain adequate blood pressure) Using these meds allows the vessels to relax and dialate. Sample ACE-I: enalapril, captopril, lisinopril also reduce afterlaod

40
Q

Aortic regurgitation pt presenation

A

Pt’s typically asymptomatic until middle age: exertional dyspnea, orthopnea, angina, PND, palpitations.
Males most common (3:1)

41
Q

Causes of aortic regurgitation

A
  1. Aortic root dilation (80% idopathic)
  2. Aging
  3. HTN
  4. Rheumatic Fever
  5. Congetial bicuspid aortic valve (normally tricuspid)
  6. Diseases
    a) marfan’s
    b) Ehlers Danlos syndrome
    c) ankylosing spondylitis
    d) systemic lupus
    e) syphilis
    Acute setting
    a) endocarditis
    b) aortic dissection
42
Q

Mitral stenosis murmur sound

A

Diastolic decrescendo-crescendo murmur with NO Radiation best heard at cardiac apex L 5th (midclavicular 4th or 5th intercostal space) Listen at the end of Expiration in the Left Lateral Decubitus position

43
Q

What exacerbates mitral stenosis murmur

A

Valsalva or exercise will exacerbate the murmur

44
Q

You may hear the following sound following S2 in mitral stenosis

A

Opening snap

45
Q

Causes of mitral stenosis

A

Rheumatic heart disease

46
Q

Mitral stenosis pt

A
  1. External dyspnea
  2. orthopnea
  3. PND 2/2/ pulmonary congestion
  4. Rales 2/2 pulmonary congestion
  5. Atrial fibrillation
47
Q

Mitral stenosis treatment

A
  1. Treat Afib (cardioversion, warfarin)
  2. Pulmonary congestion (diuretics, vasodilators)
  3. Surgery (percutaneous balloon valuloplasty vs valve replacement)
48
Q

Diagnostic for mitral stenosis

A
  1. Echo with Doppler is diagnostic.

2. Cardiac cath may help to assess overall health of heart (not diagnostic)

49
Q

Pulmonary regurgitation murmur sound

A

Early diastolic decrescendo murmur. It is heard best in the L sternal border. +/- radiation to R sternal border

50
Q

Pulmonary regurgitation is best heard in what pt position

A

Pt sitting and holding breath at end of expiration (blow out and hold breath)

51
Q

Causes of pulmonary regurgitation

A
  1. Congenital
  2. Pulmonary hypertension (increased backflow problems)
  3. endocarditis
  4. Rheumatic heart disese
  5. Plaques
  6. Iatrogenic
52
Q

Labs in pulmonary regurgitation

A
  1. ECG may show R ventricular hypertrophy
  2. Echo with doppler will show extend of regurgitation
  3. Cardiac cath may be used to gain info
53
Q

Treatment of pulmonary regurgitation

A
  1. Typically well tolerated and does not require intervention
  2. Valve may be replaced or repaired
  3. Address underlying cause of pulmonary regurgitation. It is typically a symptom of a larger problem
54
Q

Murmur in Tricuspid Stenosis

A

Diastolic decrescendo murmur best heard at left lower sternal border

55
Q

Tricuspid Stenosis and signs of heart failure

A

Signs of R heart failure will be present

56
Q

Pulmonary regurgitation and valvular pathology

A

It is the lease common valvular pathology

57
Q

Pulmonary stenosis murmur description

A

It produces a systolic crescendo-decrescendo ejection murmur WITHOUT radiation. It is best heard in the L sternal border in the 2nd - 4th intercoastal spaces

58
Q

Other characteristic sounds heard in pulmonary stenosis

A

Wide splitting of S2 (it takes longer to empty the RV.

59
Q

Pulmonary stenosis is best heard in what pt position

A

Pt is leaning foward. Valsalva ENHANCES murmur

60
Q

S2 represents

A

closing of aortic and pulmonary valves

61
Q

Labs diagnostic pulmonary stenosis

A

Echo

62
Q

Treatment pulmonary stenosis

A
  1. Follow with Echo
  2. Valvotomy
  3. Valve repair
  4. Valve replacement
63
Q

Pulmonary stenosis pt presentation

A
  1. Most pts are asymptomatic
  2. Cyonosis
  3. Dyspnea
  4. Dizziness
64
Q

Hypertrophic Obstructive Cardiomyopathy murmur sound

A

Produces systolic crescendo-decrescendo murmur best heard at the left lower sternal border

65
Q

What enhances the murmur in hypertrophic obstructive cardiomyopathy

A

Valsalva maneuver and changing positions from squatting to standing will increase the intensity of the murmur

PANRE 2019 (9 decks)

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