Murmurs

Question 1

What does Johns say you should grade most murmurs?

Answer 1

III/VI

Question 2

Where do you hear radiation of murmurs?

Answer 2

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.

Question 3

What murmur is early to mid systolic and heard over the base and radiates to carotids?

Answer 3

Aortic stenosis

Question 4

When do you hear aortic stenosis?

Answer 4

Pressure gradient of 500 mm or more or valve obstruction allows only 1/3 of area to open

Question 5

What has a holosystolic murmur heart at apex and radiates to axilla?

Answer 5

Mitral valve inufficeincy (regurg)

Question 6

Etiology of mitral regurg?

Answer 6

rhymatic heart disease (developing countries), endocarditis, acute MI resulting in papillary issues

Question 7

Pathophys of mitral regurg?

Answer 7

Acute: little enlargement of left atrium with pulmonary edema, large left atrium if chronic

Question 8

Symptoms of mitral insuffciency?

Answer 8

Acute: pulmonary edema and acute SOB. Chronic is severe fatigue and atrial fib (think of hypertrophied atrium can cause this)

Question 9

Etiology of Aortic Stenosis?

Answer 9

degenerative calcified, rheumatic f, bicuspid

Question 10

Symptoms of aortic stenosis?

Answer 10

angina (coronary flow problems b/c right after it), syncope, dyspnea on exertion

Question 11

Tx of aortic stenossi?

Answer 11

Valve replacement or balloon valvuloplasty in children/young adults

Question 12

Tx of mitral insuffciency?

Answer 12

Medically for CHF, a fib. Surgery if sever with limitations of work or routine household tasks

Question 13

What is a diastolic murmur heard best at apex in left lateral recumbent position?

Answer 13

Mitral stenosis

Question 14

What murmur is a low rumble that can have a opening snap?

Answer 14

Mitral stenosis. Diastolic and use a bell to hear it.

Question 15

What are causes of mitral stenosis?

Answer 15

Mostly rheumatic (rare in US). Congenital is possible too but raer.

Question 16

Pathophysiology of mitral stenosis

Answer 16

Orfice size decreases from 4 cm to 2 cm. Pulmonary hypertension. Can cause right ventricular failure (duh, PBL)

Question 17

Symptoms of mitral stenosis.

Answer 17

Dyspnea and cough with exertion. Hemoptysis. Arterial embolism

Question 18

Treatment of mitral stenosis.

Answer 18

Antibiotic prohylaxis, CHF, atrial fib (atrial hypertrophy). Valve replacement if valve area less than 1 cm square. MUST be very syhmptomatic before surgery

Question 19

What has a high pitched diastolic murmur heard at base?

Answer 19

Aortic insufficiency.

Question 20

When you hear “water hammer pulse”, what do you think?

Answer 20

Aortic insufficiency

Question 21

Etiology of Aortic insufficiency?

Answer 21

2/3 are rheumatic, trauma and endocarditis or congenital can also do it.

Question 22

When do you get symptoms of aortic insufficiency?

Answer 22

Increased stroke volume can cover the symptoms, but deterioration of left ventricular funciton will precede symptoms

Question 23

Symptoms of aortic insufficiency?

Answer 23

Awareness of heart rate when lying down, exertional dyspnea is first, then orthopnea and PND and angina and eventually CHF

Question 24

Why is treatment of aortic insufficiency difficult?

Answer 24

Patients are asymptomatic until myocardial issues develop and even after surgery, full function does not recover

Question 25

What is click murmur syndrome?

Answer 25

When mitral valve sips at the end of systole and why murmur comes in late. MITRALVALVE PROLAPSE

Question 26

Sound associated with mitral valve prolapse?

Answer 26

Mid or late systolic click which can be followed by high pitched murmur best heard at apex.

Question 27

Etiology of mitral valve prolapse?

Answer 27

Very common and congenital/genetic and especiially common in females

Question 28

How do you treat mitral valve prolapse?

Answer 28

Mostly benign but can cause a fib, so watch for that. Treat with reassurance b/c it is so common

Question 29

What can cause prominant A wave in jugular? and what sounds would you expect?

Answer 29

Tricuspid stenosis (rare in developed countries b/c rheumatic causes). Diastolic murmur heard ovr lower left sternal border of xiphoid.

Question 30

What causes prominent V wave? What do you hear?

Answer 30

Tricuspid regurg. Holosystolic murmur at lower left sternal border (LLSB)

Question 31

Where do you see a pulmonic stenosis?

Answer 31

Can happen in young person and is most often benign.

Question 32

Can a diastolic murmur be innocent?

Answer 32

NO NO NO NO.

Question 33

6 facts about innocent murmurs?

Answer 33

1. Systolic in nature
2. No evidence of physiologic abnormalities
3. Grade 1 or 2
4. No thrills or radiation
5. End well before S2
6. Found in 30-50% kids

Question 34

What is a thrill?

Answer 34

Seriously, I don’t know.