Murmurs Flashcards
What are the basics identifiers of heart murmurs?
- Grade I-VI (II, III most common)
- Systolic vs diastolic
- Where heard best
- Does it radiate
What are the main characteristics of aortic stenosis?
- Early to systolic murmur
- Crescendo-decrescendo, possible ejection click
- Heard best over base and tends to radiate to carotids
- late stages maybe have decreased systolic pressure and slow carotid upstroke
What are the eitology, sx’s and treatment for As?
- Degenerative calcific, rheumatic or congenital bicuspid
- Angina, syncope and dyspnea on exertion SAD
- Valve replacement, ballon valvuloplasty in children and young adults
- stenosis can cause micro-angiopathic hemolytic anemia by mechanical shearing of RBC’s
What is the pathophys of AS?
Shouldn’t be a pressure gradient from LV to aorta. Thus severe dz suggest pressure gradient of over 50mmHg
- another way is valve area (1/3 valve area means severe dz)
- can lead to LV hypertrophy and HF
how does one discriminate between AS and rheumatic Heart Dz?
In rheumatic the Aortic stenosis is caused by fusion of aortic valve commissures.
- AS its caused by fibrosis
- Rheumatic ALWAYS has mitral stenosis involvement with AS.
What are some characteristics of mitral insufficiency?
Holosystolic “blowing murmur”
- apex and radiates to axilla
- 5th intercostal space
- Louder when squatting and expiration
What is the etiology of MR?
- ACUTE RHD
- Congenital
- Acute MI with papillary muscle dysfunction
- Endocarditis
- Calcification with age
- MV prolapse
- LV dilation (pulls valve apart)
What are some consequences of mitral regurge?
Left atrial enlargement and pulmonary edema
- Acute SOB
- Fatigue
- A-fib
What is the treatment for mitral regurge?
Treat CHF medically and a-fib
- Surgery
Why does squatting and expiration lead to louder MR murmur?
Squatting increases systemic tension and thus increases LV tension and decreased LV emptying
- Expiration moves blood from lungs to left atrium leading to increase SV
What are some characteristics of mitral stenosis?
Diastolic murmur heart best at apex with patient laying on left side
- Low pitched rumble
- Opening snap
- Caused by chronic RHD and rarely congenital
Symptoms of MS? Treatment?
Dyspnea with exertion and cough
- hemoptysis (bloody cough)
- Arterial embolism
- Antibiotic prophylaxis, CHF, A-fib and valve replacement is less than 1.0 cm2
What is the pathophys of MS?
4-6 cm2= normal orfice
- Pulmonary HTN
- Pulmonary edema
- mural thrombi
- Left atrial pressure
- Resultant Right ventricular failure
what are some characteristics of aortic insufficiency?
High pitched diastolic murmur at base
- Best heart when pt is sitting
- Water hammer pulse
- Increased pulse pressure
- Louder and longer with increased severity
- Decrescendo murmur
What are the causes of AI?
- Rheumatic hd
- endocarditis
- Trauma
- Congenital (marfans) or bicuspid
Most commonly from aortic root dilation by syphilitic aneurysm or aortic dissection
