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PCA > Murmurs > Flashcards

Murmurs Flashcards

1
Q

What is a murmur?

A

direct result of blood flow turbulence

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2
Q

The amount of turbulence =

A

intensity of the murmur

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3
Q

Where are mitral murmurs best heard at?

A

the apex

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4
Q

Atrial septal defect is ________

A

diastolic

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5
Q

Ventricular septal defect is ______

A

systolic

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6
Q

Intensity of a murmur

A

determined by the quantity and velocity (turbulence)

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7
Q

Factors that affect turbulence of a murmur

A

The size of the orifice or vessel through which the blood flows
The pressure difference (gradient)
The volume of blood

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8
Q

The transmission of intensity of a murmur is also dependent on the characteristic of tissue between the blood flow and the stethoscope. Explain high and low intensities

A

Higher intensity: Low BMI individuals
Lower intensity: Air (emphysema), fluid (pericardial effusion), fat (high BMI)

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9
Q

What are the grades of intensity of a murmur and what does each mean?

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

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10
Q

Describe pitch, high/low

A

High pitch: best heard with diaphragm
Low pitch: best heard with bell

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11
Q

Describe what the quality of a murmur can be

A

Harsh, rumbling, blowing, musical

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12
Q

What are configurations of murmurs?

A

Configuration: The time course of murmur intensity

Crescendo: Increasing

Decrescendo: Decreasing

Crescendo-decrescendo: Increases then decreases

Plateau: Intensity doesn’t change

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13
Q

How is the duration of a murmur assessed?

A

by determining the timing of the murmur relative to the cardiac cycle

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14
Q

What are systolic murmurs?

A

starts with or after S1 and terminates with or before S2

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15
Q

Early systolic murmur

A

Obscures S1, does not extend to S2

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16
Q

Mid systolic murmur

A

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

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17
Q

Holosystolic (pansystolic) murmur

A

obscures both S1 and S2, lasts entire duration

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18
Q

Late systolic murmur

A

starts after S1, extends to S2

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19
Q

What are systolic murmurs?

A

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

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20
Q

Mitral regurgitation

A

The mitral valve is a bicuspid valve

The valve opening is enclosed by a fibrous ring = mitral valve annululs

The mitral valve leaflets are attached to chordae tendineae
Tendon-like projections that prevent prolapse of leaflets and regurgitation of blood back into the left atrium

The chordae tendineae are further attached to papillary muscles that attach to the left ventricular walls

21
Q

What is mitral regurgitation caused by?

A

a leaky, or incompetent, valve causing backwards flow of blood from the left ventricle into the left atrium

22
Q

What are the primary causes of mitral valve regurgiation?

A

Mitral valve prolapse
Ischemic (coronary artery disease)
Rheumatic heart disease
Endocarditis

23
Q

What are the secondary causes of mitral valve regurgitation?

A

The result of progressive enlargement of the left ventricle leading to mitral annular dilatation and displacement of the papillary muscles

24
Q

Mitral valve regurgitation (systolic murmur)

A

Timing: Early systolic or holosystolic

Location: Apex

Radiation: Axilla

Intensity correlates with severity

Quality: High pitched, blowing

Pitch: Medium

25
Q

For the mitral regurgitation (systolic murmur), ______ is soft due to poor closure of the MV

A

S1

26
Q

During the mitral regurgitation (systolic murmur), ________ and _______ are present due to volume overload

A

ventricular gallop (S3), atrial gallop (S4)

27
Q

What are the associated clinical findings with mitral regurgitation (systolic murmur)

A

Hyperdynamic or displaced apical impulse (PMI)
Heart failure if degree of MR is severe
Atrial fibrillation is common

28
Q

What is mitral valve prolapse?

A

the mitral valve may have redundant or elongated chordae tendineae causing an abnormal ballooning of the mitral valve leaflets during systole

29
Q

MVP is associated with a ______ click

A

systolic, as the leaflets snap back into place

30
Q

MVP is associated with a murmur ONLY when ______ is present as well, typically mid to late systolic

A

Mitral regurgitation

31
Q

What is the most common cause of mitral regurgitation?

A

MVP

32
Q

What is aortic stenosis?

A

The normal aortic valve opens completely during systole, allowing outflow of blood from the LV

Aortic leaflets will calcify over time, causing the valve to narrow

33
Q

The aortic valve is usually _______ but can also be ________ or ________

A

tricuspid, bicuspid or unicuspid

34
Q

Symptom onset of valvular aortic stenosis

A

Unicuspid: early childhood
Bicuspid: 40-70 years of age
Tricuspid: 70+

35
Q

Aortic stenosis (systolic murmur)

A

Timing: Midsystolic, crescendo-decrescendo

Location: Right 2nd intercostal space (aortic area)

Radiation: Neck

Intensity correlates with severity

Quality: Harsh, rough

Pitch: Low, but becomes high pitched when very severe

36
Q

T/F Aortic stenosis has thrills that may be palpable

A

True

37
Q

Aortic stenosis has complete loss of _______

A

S2

38
Q

Aortic stenosis has an early ___________ due to heavily calcified valve

A

systolic click

39
Q

What are the associated clinical findings with aortic stenosis?

A

Angina
Syncope
Exertional dyspnea
Heart failure

40
Q

Ventricular septal defect is a _______ defect

A

congenital

41
Q

What type of murmur is VSD?

A

holosystolic from a continuous right shunt during systole

42
Q

VSD is _______, often easily detectable

A

loud

43
Q

Which murmur can many patients tolerate into adulthood with good functional status?

A

VSD

44
Q

VSD(stytolic murmur)

A

Timing: Holosystolic

Location: Left or right 3rd/4th intercostal spaces

Radiation: left clavicle

Intensity: Loud, may have a thrill

Quality: Harsh

Pitch: low pitch – small defects ; high pitch – larger defects

45
Q

What is tricuspid regurgitation?

A

Backwards flow of blood from the right ventricle back into the right atrium during systole

46
Q

What are the primary causes of Tricuspid regurgitation?

A
  1. Endocarditis
  2. Myocardial infarction > RV dilatation >valve incompetence
  3. Right ventricular pacemaker leads (iatrogenic)
47
Q

What are the secondary causes of tricuspid regurgitation?

A

Pulmonary artery hypertension

48
Q

Tricuspid regurgitation (Systolic murmur)

A

Timing: Holosystolic

Location: Left lower sternal border, 4th intercostal space (tricuspid area)

Radiation: Epigastric area

Intensity: Increases during inspiration due to increased right sided venous return, decreased with Valsalva

Quality: soft, often difficult to hear

Pitch: High pitch

49
Q

What are the associated clinical findings with tricuspid regurgitation?

A
  1. PMI may be displaced to epigastric area if RV very enlarged
  2. May have a wide split S2
  3. S3 or S4 originating from the right side of the heart
  4. Findings consistent with right heart failure
    -JVP
    -Ascites, abdominal distension
    -Lower extremity edema

PCA (17 decks)

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