Murmurs Flashcards
Ohm’s law of hydrodynamics
Flow equals the change in pressure over resistance
Poisseulle-Hagen equation
Flow = deltaP x pi r^4 x viscosity x L
Point at which laminar flow becomes turbulent
Reynold’s number = (2 DxVelocityxDensity) over viscosity
Reynold’s number where flow becomes highly turbulent
> 3,000
Reynold’s number where flow is laminar
<2,000
Differentials for systolic murmur heard over the aortic area
Aortic stenosis
Aortic valve sclerosis
Physiologic
Differentials for systolic ejection murmur heard over the pulmonic area
Pulmonic stenosis
Differentials for diastolic murmur heard over the left sternal border
Aortic regurgitation
Pulmonic regurgitation
Differentials for systolic murmur heard over the left sternal border
Hypertrophic cardiomyopathy
Differentials for diastolic murmur heard over the tricuspid area
ASD
Tricuspid stenosis
Differentials for systolic murmur heard over the tricuspid area
Tricuspid regurgitation
VSD
Differentials for holosystolic murmur heard over the mitral area
Mitral regurgitation
Differentials for diastolic murmur heard over the mitral area
Mitral stenosis
Differentials for systolic murmur heard over the mitral area
Mitral valve prolapse
Maneuvers that increase preload/venous return
Squatting
Passive leg raise
Volume administration (IV fluid)
Maneuvers that increase afterload
Squatting
Vasopressors
Sustained hand grip
Transient arterial occlusion (BP cuff on both UE)
Maneuvers that decrease preload/venous return
Valsalva maneuver
Standing
Rapid standing from squat
Nitroglycerin
Maneuver to decrease afterload
Inhaled amyl nitrite
Murmurs that increase with increased preload
Aortic stenosis and regurgitation
Mitral stenosis and regurgitation
Murmurs that decrease with increased preload
HOCM - hypertrophic obstructive cardiomyopathy
Mitral valve prolapse
Murmurs that increase with increased afterload
Mitral regurgitation
Aortic regurgitation
Murmurs that decrease with increased preload
Aortic stenosis
HOCM
Mitral valve prolapse
Murmurs that increase with decreased preload
HOCM
Mitral valve prolapse
Murmurs that decrease with decreased preload
Aortic stenosis and regurgitation
Mitral stenosis and regurgitation
Murmurs that decrease with decreased afterload
Mitral regurgitation
Aortic regurgitation
Murmurs that increase with decreased afterload
Aortic stenosis
HOCM
Mitral valve prolapse
Murmurs that increase with squatting
Mitral regurgitation
Aortic regurgitation and stenosis
Affect of squatting on murmur of mitral valve prolapse
Delayed click and shortening
Murmur decreased by squatting
HOCM
Mitral valve prolapse
Murmur increased by sustained hand grip
Mitral regurgitation
Murmurs decreased by sustained hand grip
HOCM
Mitral valve prolapse
Aortic stenosis
Signs of adequacy of Valsalva maneuver
Neck V distension
Increased tone of abdominal wall muscles
Flushed face
Effect of Valsalva maneuver
Acute increase in intrathoracic and abdominal pressure resulting in decreased venous return to RA
Murmurs that are decreased in Valsalva maneuver
Aortic stenosis and regurgitation
Mitral stenosis and regurgitation
Murmurs that are increase in Valsalva maneuver
HOCM
Mitral valve stenosis
Murmurs increased after administration of inhaled amyl nitrite
Aortic stenosis
HOCM
Mitral valve prolapse
Affect of inspiration on murmurs
Increased intensity of R sided murmurs
Affect of expiration on murmurs
Increased intensity of L sided murmurs
Murmur type that is not affected by changes in afterload
Mitral stenosis
