Murmurs Flashcards by Korey koper

Most common kind of heart murmur?

Midsystolic murmur

How well did you know this?

Not at all

Perfectly

Types of mid systolic murmurs?

innocent (stills)
physiologic
pathologic

How well did you know this?

Not at all

Perfectly

Types of Mid-systolic - pathologic types?

Aortic stenosis
pulmonary stenosis
HOCM

How well did you know this?

Not at all

Perfectly

Innocent murmur?

benign
children
2-4 ICS between LSB and apex
grade 1-2
decrease or absent with sitting

How well did you know this?

Not at all

Perfectly

Physiologic Murmurs?

similar to innocent

increased flow

How well did you know this?

Not at all

Perfectly

Physiologic Murmur causes?

anemia
pregnancy
fever
hyperthyroidism

How well did you know this?

Not at all

Perfectly

Aortic stenosis path?

Degenerative calcification or congenital or rheumatic ( aortic leaflets

Valve stiffens, opening narrows

Right 2nd ICS

S2 may decrease

Thrill

How well did you know this?

Not at all

Perfectly

Aortic stenosis radiates to?

carotid

How well did you know this?

Not at all

Perfectly

Aortic stenosis character and shape?

Harsh, crescendo-decrescendo

How well did you know this?

Not at all

Perfectly

Aortic Stenosis heard best when?

patient is sitting and leaning forward - bring aorta valve closer to the chest

How well did you know this?

Not at all

Perfectly

Aortic Stenosis valsalva ?

↑with squatting, ↓ with standing

How well did you know this?

Not at all

Perfectly

Pulmonic Stenosis patho?

Congenital, usually found in children

Early – pulmonic ejection sound

Severe – S2 splits, often widely - cause it is affecting the right side of the heart (inspiration affect right side of the heart)

May lead to RV failure

If loud, may have a thrill

How well did you know this?

Not at all

Perfectly

Pulmonic Stenosis radiates to?

toward left shoulder or neck

How well did you know this?

Not at all

Perfectly

Pulmonic stenosis character and shape?

Harsh quality

Crescendo-decrescendo

How well did you know this?

Not at all

Perfectly

Pulmonic stenosis location?

2nd and 3rd left interspaces

How well did you know this?

Not at all

Perfectly

HOCM path?

Massive ventricular hypertrophy

Sustained apical impulse

How well did you know this?

Not at all

Perfectly

HOCM location?

3rd and 4th left interspaces

May have S3 and S4 at apex

How well did you know this?

Not at all

Perfectly

HOCM radiates?

down LSB to apex

How well did you know this?

Not at all

Perfectly

HOCM character?

Harsh

How well did you know this?

Not at all

Perfectly

HOCM valsalva ?

Decreased with squatting

Increased with standing and Valsalva strain

How well did you know this?

Not at all

Perfectly

Squatting _________ venous return to the heart, _________ PVR and vol in LV _________.

increases
increases
increases

How well did you know this?

Not at all

Perfectly

Standing _________ venous return to the heart, _________ PVR and vol in LV _________.

decreases
decreases
decreases

How well did you know this?

Not at all

Perfectly

Midsystolic Click?

Mitral Valve Prolapse

AKA Barlow’s syndrome

How well did you know this?

Not at all

Perfectly

Mitral Valve Prolapse patho?

Leaflet redundancy and elongation of chordae tendinae

Part of valve balloons into left atrium, allows backflow of blood

Common, M=F

May be associated with a MR murmur

How well did you know this?

Not at all

Perfectly

Mitral Valve Prolapse pitch and shape?

high pitch | crescendo

Mitral Valve Prolapse valsalva?

Squatting widens (delays) the click

Pansystolic Murmurs ( Holosystolic)?

Mitral Regurgitation Tricuspid Regurgitation Ventricular Septal Defect

Mitral Regurgitation patho?

Mitral valve does not fully close in systole Back flow of blood from LV to LA Creates volume overload on LV with subsequent dilation

Mitral Regurgitation may develop __ at apex?

Mitral Regurgitation radiates to?

to left axilla

Mitral Regurgitation is ___ louder with inspiration.

NOT

Mitral Regurgitation pitch and character?

medium pitch | harsh

Tricuspid Regurgitation patho?

Backward flow from RV to RA Most commonly due to RV failure and dilatation

Tricuspid Regurgitation location?

Heard along lower LSB

Tricuspid Regurgitation radiates to ?

RSB and xiphoid area

Tricuspid Regurgitation character?

Blowing

Tricuspid Regurgitation _________ with inspiration.

Increases

Ventricular Septal Defect patho?

Congenital defect in intraventricular septum Flows from LV (high pressure) to RV (low pressure)

Ventricular Septal Defect location?

Left 3rd, 4th, 5th interspaces

VSD pitch, character ?

Loud, thrill, harsh, high pitch Larger defects may be quieter

Diastolic Murmurs example?

``` Aortic Regurgitation (early diastolic) Mitral Stenosis (mid diastolic) ```

Aortic Regurgitation patho?

Aortic valve doesn’t close completely Backward flow from aorta to LV LV overload May be associated with aortic flow murmur or Austin Flint murmur (mitral diastolic)

Aortic Regurgitation location?

2nd to 4th L interspaces

Aortic Regurgitation radiates to?

apex

Aortic Regurgitation pitch, character, and shape?

high to low pitch blowing decrescendo

Aortic Regurgitation heard best when?

patient sitting leaning forward breathe held exhaled

Mitral Stenosis patho?

Mitral valve thickens, stiffens or distorts from rheumatic fever Does not fully open May hear opening snap after S2 Accentuated S1

Mitral Stenosis pitch and location?

Low pitch rumble, at apex

Mitral Stenosis radiation?

none

Mitral Stenosis shape?

decrescendo

Mitral Stenosis best heard when ?

LLD

Continuous Murmurs?

Venous Hum Pericardial Friction Rub Patent Ductus Arteriosus Both systolic and diastolic components - all throughout the cardiac cycle and the valve no not involved

Venous Hum patho?

Turbulence of flow in the jugular veins Benign, more common in children Can obliterate with pressure on jugular vein or by turning the head

Venous Hum description?

Continuous, louder in diastole

Venous Hum location?

Above medial 1/3 of clavicles, esp on R

Is Venous Hum an Low pitch?

yes listen with bell

Pericardial Friction Rub patho?

Inflammation of the pericardial sac

Pericardial Friction Rub character and pitch?

Scratchy, high pitch

Pericardial Friction Rub best heard when?

May ↑ with sitting, lean forward, hold breath in exhale

Pericardial Friction Rub location?

best heard at 3rd ICS, LSB

Patent Ductus Arteriosus patho?

Congenital opening between the aorta and pulmonic artery. Should have closed at birth Loudest in late systole (obscures S2) May have a thrill

Patent Ductus Arteriosus location?

Left 2nd ICS

Patent Ductus Arteriosus radiates to?

toward left clavicle

Patent Ductus Arteriosus character ?

Harsh, Machinery like

Acute Coronary Syndrome (ACS) patho?

Any syndrome caused by acute myocardial ischemia Associated with a friction rub

Acute Coronary Syndrome (ACS) results in?

unstable angina NSTEMI STEMI

Pericarditis patho?

Retrosternal chest pain - right in the middle | Sharp!

Pericarditis is _____ with position changes, cough

worse angina does not change with position changes

Pericarditis is ______ with sitting up and leaning forward.

better

Aortic Dissection patho?

blood in false lumen anterior chest pain radiating to back or neck Tearing ripping severe or acute

What is Cardiac Tamponade?

a build-up of blood or other fluid in the pericardial sac puts pressure on the heart, which may prevent it from pumping effectively; fluid build-up within pericardial sac

Heart Failure patho?

Diastolic or systolic dysfunction Often results in fluid overload

Heart Failure symptoms ?

Dyspnea Orthopnea Paroxysmal nocturnal dyspnea Edema (dependent) DOPE

Heart Failure JVP and HJR results?

Increased JVP and positive HJR S3 and S4 too

Hypertension chronic will displace the PMI _________. - LVH.

laterally Sustained, bounding pulse