Murmurs Flashcards
What is the 1st heart sound caused by?
the closing of the atrioventricular valves (the tricuspid and mitral valves)
What is the 2nd heart sound caused by?
the closing of the semilunar valves (the pulmonary and aortic valves)
What is the 3rd heart sound caused by?
Heard roughly 0.1 seconds after the second heart sound.
This can be normal in young (15-40 years) healthy people. In older patients it can indicated heart failure, as the ventricles and chordae are stiff and weak, so they reach their limit much faster than normal.
Results from increased atrial pressure leading to increased flow rates, as seen in congestive heart failure, which is the most common cause of a S3. Associated dilated cardiomyopathy with dilated ventricles also contribute to the sound.
What is the 4th heart sound?
Heard directly before S1.
This is always abnormal and relatively rare to hear. It indicates a stiff or hypertrophic ventricle and is caused by turbulent flow from an atrium contracting against a non-compliant ventricle.
What mnemonic is used for systolic murmurs?
Please Sneak Away Slowly MR TigeR.
Pulmonary stenosis, Aortic stenosis, mitral regurgitation, tricuspid regurgitation
What mnemonic is used for diastolic murmurs?
ARMS PaRTS
Aortic regurgitation, mitral stenosis, pulmonary regurgitation, tricuspid stenosis
Where is Erb’s point?
Third intercostal space on the left sternal border and is the best area for listening to heart sounds (S1 and S2).
Where is best for listening to pulmonary murmurs?
2nd I.C.S left sternal border
Where is best for listening to aortic murmurs?
2nd I.C.S right sternal border
Where is best for listening to tricuspid murmurs?
5th I.C.S left sternal border
Where is best for listening to Mitral murmurs?
5th I.C.S mid axillary line (apex area)
What special maneuver can be used to emphasize mitral stenosis
Patient on their left-hand side
What special maneuver can be used to emphasize aortic regurgitation?
Patient sat up, learning forward and holding exhalation
During a cardiac examination, a patient may be asked to lie on their left hand side to emphasize a murmur; what murmur is this?
Mitral stenosis
During a cardiac examination, a patient may be asked to “sit up, lean forward & hold their breath on exhalation” to emphasize a murmur; what murmur is this?
aortic regurgitation
What change does a stenotic valve cause to the heart?
When pushing against a stenotic valve the muscle has to try harder resulting in hypertrophy
What change does a leaky valve cause to the heart?
When a leaky valve allows blood to flow back into a chamber it stretches the muscle resulting in dilatation:
What heart change is observed in mitral/aortic stenosis?
Causes left atrial hypertrophy/left ventricular hypertrophy respectively;
(Pushing against a stenotic valve means the muscle has to try harder resulting in hypertrophy)
