Murmurs Flashcards
S1
closure of AV valves
AV valves
mitral and tricuspid
S2
closure of SL valves
SL valves
aortic and pulmonic
systolic ejection, crescendo-decrescendo mumur
radiates to carotid artery w/ narrow pulse pressure that is mid-systolic
aortic stenosis
blowing decrescendo rumbling murmur, high pitch no radiation
aortic regurg
rumbling decrescendo mid-diastolic w/ opening snap mumumur and no radiation
mitral stenosis
holocystolic blowing murmur radiates to left axilla
mitral regurg
crescendo- decresendo murmur heard at the left upper sternal border; systolic ejection murmur
pulmonic stenosis
high pitched decresendo mumur
pulm regurg
soft opening, scratching rumble w/ increased JVD murmur?
tricuspid stenosis
holocystolic murmur high pitched blowing
tricuspid regurg
What are the midsystolic murmurs?
- aortic stenosis
- pulmonic stenosis
- atrial septal defect
- HOCM
What are the holosystolic murmurs?
- mitral regurgitation
- tricuspid regurgitation
- VSD
What is the late systolic murmur?
mitral valve prolapse (lapse = late)
what are the early diastolic murmurs?
- aortic regurgitation
- pulmonic regurgitation
- austin-flint
what is the mid/late diastolic murmur?
- mitral stenosis
- tricuspid stenosis
rumbling-diastolic (mid-late) best heard at the apex, severe aortic regurg
austin- flint murmur
what murmurs increase and decrease with inspiration?
right increase
left decrease
what murmurs increase and decrease with squatting?
increase MS, AS, aortic insufficency
decrease Hypertrophic cardiomyopathy
what increases and decreases with standing?
increases hypertrophic cardiomyopathy
decreases aortic stenosis, MR
what increases and decreases with valsalva?
increases hypertrophic cardiomyopathy, MVP
decreases almost all
What is HFrEf?
LV systolic dysfunction with S3 gallop
impaired contractility
increased diastolic
EF< 40 %
What is HFpEF?
LV filling and relaxation impaired
EF> 40%
S4 gallop
What are all the NYHA classes?
Class 1: no limitations of physical activity
Class 2: slight limitations, sxs w/ moderate exertion
class 3: mod. limitations, sxs w/ mild exertion
class 4: unable to carry out any physical activity w/o discomfort
Right sided HF s/s
systemic
ascites, hepatomegally, decreased bowel perfusion
JVD
S/S of left sided heart failure
think pulmonary
crackles at the lung base
dullness to percusion
JVD, displaced PMI
peripheral edema
orthopnea
chronic cough
What is the treament guideline for heart failure?
ARNI (entresto)
ACEI (pril)/ arbs (sartan)
BB
SGT2-I ( jardiance/ forxiga)
MRA (spironolactone)
loop diuretics
What are the two IV medications for heart failure?
Iv dobutamine and Iv milrnone
Explain all of dilated cardiomyopathy? causes? S/S? PE? DX? TX?
Causes: “ Im mad my pump failed”
Idiopathic, myocarditid, alcohol, drugs, medications, pregnancy, family inherited
S/S: extertional intolerance
PE: pulmonary rales, S3 Gallop, periheral edema, ascites
TX: underlying causes + HErEF treatment
Explain all of Hypertrophic cardiomyopathy? causes? S/S? PE? DX? TX?
Causes: genetic, diastolic dysfunction
asymmetrical growth - left ventricle larger
s/s: syncope (SOB w/ activity, exertional fatigue)
PE: murmur decreased w/ squatting or hadgrips
murmur increased w/ valsalba + rapid movement
EKG: LVH
echo (gold standard): EF < 60 %
TX: BB
Explain all of Restrictive cardiomyopathy? causes? S/S? PE? DX? TX?
systolic and diastolic dysfunction
Causes: amyloidosis (mc)
S/S: SOB, fatigue, peripheral edema, hepatomegally
Dx: echo -> small ventricles that are thick or rigid w/ pulmanary HTN
EF: -> 20- 50 %
Tx: Diuretics + bp
Explain all of stress cardiomyopathy? causes? S/S? PE? DX? TX?
Tako-tsubo syndrome ( broken heart syndrome)
EKG: ST-elevation w/ deep anterior T wave inversion, LV wall thickening
Tx: similar to MI -> ASA, BB, ACEI
Aortic Stenosis Triad?
- Chest pain
- Dyspnea
- Syncope
