Murmurs Flashcards
What does Johns say you should grade most murmurs?
III/VI
Where do you hear radiation of murmurs?
If heard in base of heart, it goes through carotids, if it is in the apex of the heart, you hear it in the axilla.
What murmur is early to mid systolic and heard over the base and radiates to carotids?
Aortic stenosis
When do you hear aortic stenosis?
Pressure gradient of 500 mm or more or valve obstruction allows only 1/3 of area to open
What has a holosystolic murmur heart at apex and radiates to axilla?
Mitral valve inufficeincy (regurg)
Etiology of mitral regurg?
rhymatic heart disease (developing countries), endocarditis, acute MI resulting in papillary issues
Pathophys of mitral regurg?
Acute: little enlargement of left atrium with pulmonary edema, large left atrium if chronic
Symptoms of mitral insuffciency?
Acute: pulmonary edema and acute SOB. Chronic is severe fatigue and atrial fib (think of hypertrophied atrium can cause this)
Etiology of Aortic Stenosis?
degenerative calcified, rheumatic f, bicuspid
Symptoms of aortic stenosis?
angina (coronary flow problems b/c right after it), syncope, dyspnea on exertion
Tx of aortic stenossi?
Valve replacement or balloon valvuloplasty in children/young adults
Tx of mitral insuffciency?
Medically for CHF, a fib. Surgery if sever with limitations of work or routine household tasks
What is a diastolic murmur heard best at apex in left lateral recumbent position?
Mitral stenosis
What murmur is a low rumble that can have a opening snap?
Mitral stenosis. Diastolic and use a bell to hear it.
What are causes of mitral stenosis?
Mostly rheumatic (rare in US). Congenital is possible too but raer.
Pathophysiology of mitral stenosis
Orfice size decreases from 4 cm to 2 cm. Pulmonary hypertension. Can cause right ventricular failure (duh, PBL)
Symptoms of mitral stenosis.
Dyspnea and cough with exertion. Hemoptysis. Arterial embolism
Treatment of mitral stenosis.
Antibiotic prohylaxis, CHF, atrial fib (atrial hypertrophy). Valve replacement if valve area less than 1 cm square. MUST be very syhmptomatic before surgery
What has a high pitched diastolic murmur heard at base?
Aortic insufficiency.
When you hear “water hammer pulse”, what do you think?
Aortic insufficiency
Etiology of Aortic insufficiency?
2/3 are rheumatic, trauma and endocarditis or congenital can also do it.
When do you get symptoms of aortic insufficiency?
Increased stroke volume can cover the symptoms, but deterioration of left ventricular funciton will precede symptoms
Symptoms of aortic insufficiency?
Awareness of heart rate when lying down, exertional dyspnea is first, then orthopnea and PND and angina and eventually CHF
Why is treatment of aortic insufficiency difficult?
Patients are asymptomatic until myocardial issues develop and even after surgery, full function does not recover
What is click murmur syndrome?
When mitral valve sips at the end of systole and why murmur comes in late. MITRALVALVE PROLAPSE
Sound associated with mitral valve prolapse?
Mid or late systolic click which can be followed by high pitched murmur best heard at apex.
Etiology of mitral valve prolapse?
Very common and congenital/genetic and especiially common in females
How do you treat mitral valve prolapse?
Mostly benign but can cause a fib, so watch for that. Treat with reassurance b/c it is so common
What can cause prominant A wave in jugular? and what sounds would you expect?
Tricuspid stenosis (rare in developed countries b/c rheumatic causes). Diastolic murmur heard ovr lower left sternal border of xiphoid.
What causes prominent V wave? What do you hear?
Tricuspid regurg. Holosystolic murmur at lower left sternal border (LLSB)
Where do you see a pulmonic stenosis?
Can happen in young person and is most often benign.
Can a diastolic murmur be innocent?
NO NO NO NO.
6 facts about innocent murmurs?
- Systolic in nature
- No evidence of physiologic abnormalities
- Grade 1 or 2
- No thrills or radiation
- End well before S2
- Found in 30-50% kids
What is a thrill?
Seriously, I don’t know.
