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EOR Family med > Murmurs > Flashcards

Murmurs Flashcards

1
Q

pathophysiology of aortic stenosis

A

LV outflow obstruction leads to a fixed cardiac output, increased after load, left ventricular hypertrophy, and eventually LV failure

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2
Q

what is the most common valvular disease

A

aortic stenosis

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3
Q

sx aortic stenosis

A

exertional dyspnea MC sx
decreased exercise tolerance
angina
syncope
CHF

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4
Q

describe the sounds/quality for aortic stenosis

A

harsh, low pitched, mid-late peaking, systolic, crescendo-decrescendo murmur best heart at the right upper sternal border and radiates to the carotid arteries

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5
Q

when does aortic stenosis increase

A

sitting while leaning forward
increased venous return (squatting, supine, leg raise)
expiration
decreased after load (inhalation of amyl nitrate)

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6
Q

when does aortic stenosis decrease

A

decreased venous return (valsalva, standing)
inspiration
increased afterload (handgrip)

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7
Q

PE aortic stenosis

A

weak, delayed carotid pulse
narrow pulse pressure
fourth heart sound (S4)

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8
Q

Test of choice for aortic stenosis and what will it show

A

echocardiogram
small aortic orifice
LVH
thickened/calcified aortic valve

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9
Q

what will you see on EKG for aortic stenosis

A

LVH

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10
Q

definitive diagnosis for aortic stenosis

A

cardiac catheterization

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11
Q

only effective tx for aortic stenosis

A

aortic valve replacement

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12
Q

aortic regurgitation

A

incomplete aortic valve closure leading to regurgitation of blood through the aortic valve into the left ventricle during diastole

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13
Q

two most common causes of aortic regurgitation

A

endocarditis
aortic dissection

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14
Q

quality/sound of aortic regurgitation

A

high pitched, blowing, decrescendo or sustained, diastolic murmur best heard over Era’s point

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15
Q

when does aortic regurgitation increase

A

sitting up while leaning forward
holding breath in end-expiration
increased venous return (squatting, supine, leg raise)
increased after load (handgrip)

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16
Q

when does aortic regurgitation decrease

A

decreased venous return (valsalva, standing)
inspiration
decreased after load (amyl nitrate)

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17
Q

what else will you see on PE for aortic regurgitation

A

bounding ulses
pulses bisferiense
wide pulse pressure (increased SBP and decreased DBP)

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18
Q

tx for aortic regurgitation

A

after load reduction - ACEI, ARBs, Nifedipine, Hydralazine

surgery is definitive

aortic valve replacement for emergency

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19
Q

mitral stenosis

A

narrowing of the mitral valve orifice leading to obstruction of flow from the left atrium to the left ventricle and back flow of blood into the left atrium

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20
Q

pathophysiology of mitral stenosis

A

obstruction of flow from LA to LV –> blood backs up into left atrium –> pulmonary congestion –> pulmonary HTN –> CHF

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21
Q

Sx mitral stenosis

A

exertion dyspnea (MC)
exercise intolerance
hemoptysis
cough
pulmonary HTN
Afib

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22
Q

what are mitral facies commonly seen in mitral stenosis

A

ruddy (flushed) cheeks with facial pallor (chronic hypoxia)

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23
Q

PE for mitral stenosis

A

prominent (loud) S1
opening snap
loud P2

24
Q

sounds/quality mitral stenosis

A

low-pitched, mid-diastolic, rumbling murmur best heard at the mitral area/apex (left fifth intercostal space at the mid-clavicular line)

25
Q

increase sound for mitral stenosis

A

left lateral decubitus position
expiration
increased venous return (squatting, leg raise, lying, supine)

26
Q

decreased sound mitral stenosis

A

decreased venous return (valsalva, standing)
inspiration
amyl nitrate

27
Q

what will EKG show for mitral stenosis

A

left atrial enlargement
Afib
pulmonary HTN (RVH, right axis deviation)

28
Q

tx for mitral stenosis

A

percutaneous balloon valvuloplasty

29
Q

what is almost always the cause of mitral stenosis

A

rheumatic heart disease

30
Q

mitral regurgitation

A

incomplete closure of mitral valve, leading to retrograde blood from from left ventricle to left atrium during systole

31
Q

compensatory consequences to mitral regurgitation

A

left atrial dilation
left ventricular hypertrophy

32
Q

most common cause of mitral regurgitation

A

mitral valve prolapse

33
Q

sx mitral regurgitation

A

exertional dyspnea
Afib
dyspnea at rest
pulmonary edema
hypotension
tachypnea
hypoxemia
cyanosis
decreased cardiac output
possible cardiogenic shock

34
Q

sounds/quality of mitral regurgitation

A

high-pitched, blowing, holosystolic murmur best heard at the apex, often with radiation to the left axilla, sub scapular region, or upper sternal borders

35
Q

increased mitral regurgitation

A

left lateral decubitus
expiration
increased venous return (squatting, leg raise, supine)
increased afterload (handgrip)

36
Q

decreased mitral regurgitation

A

decreased venous return (valsalva, standing)
inspiration
decreased after load (amyl nitrate)

37
Q

Tx for mitral regurgitation

A

after load reducers (ACEI, ARBs, hydralazine, nitrates)

repair is generally preferred over replacement

38
Q

in what population is mitral valve prolapse MC

A

young women (15-35 years old)

39
Q

causes of mitral valve prolapse

A

myxomatous degeneration - weakened and elongated chord tendineae, mitral annular dilation, thickened leaflet tissue

connective tissue diseases - Marfan or Ehlers-Danlos syndromes, osteogenesis imperfecta

40
Q

sx for mitral valve prolapse

A

most asx

if sx - atypical chest pain, palpitations, exertion dyspnea, dizziness, etc

41
Q

sounds/quality mitral valve prolapse

A

mid-late systolic click best heard at the apex

42
Q

earlier click and longer duration MVP

A

any maneuver that makes LV smaller or decreases preload (valsava, standing)

43
Q

later click and shorter duration MVP

A

any maneuver that increases preload (squatting, supine, leg raise)
handgrip

44
Q

tx for asx MVP

A

reassurance

45
Q

tx for MVP w autonomic dysfunction

A

beta blockers

46
Q

MC cause of primary pulmonic regurgitation

A

almost always congenital

47
Q

Pathophysiology of pulmonary regurgitation

A

back flow of blood from pulmonary artery to RV –> right sided volume overload

48
Q

sx pulmonary regurgitation

A

insignificant
if sx - associated w right sided HF –> hepatic congestion, ascites, jugular venous distention, lower extremity edema

49
Q

PE for pulmonic regurgitation

A

Graham steel murmur - brief high-pitched decrescendo early diastolic blowing murmur

heard at left upper sternal border

50
Q

increased pulmonic regurgitation

A

inspiration
increased venous return (squatting, supine, leg raise)

51
Q

decrease pulmonic regurgitation

A

expiration
decreased venous return

52
Q

tricuspid stenosis

A

stenosed valve –> back flow of blood from RV to RA –> right sided heart failure

53
Q

sound/quality tricuspid stenosis

A

mid-diastolic murmur at left lower sternal border

54
Q

increased intensity tricuspid stenosis

A

increased venous return (squatting, supine, leg raise)
inspiration

55
Q

PE tricuspid stenosis

A

opening snap

56
Q

tricuspid regurgitation

A

EOR Family med (25 decks)

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