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Patient Evaluation > Murmurs > Flashcards

Murmurs Flashcards

1
Q

Most common kind of heart murmur?

A

Midsystolic murmur

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2
Q

Types of mid systolic murmurs?

A

innocent (stills)
physiologic
pathologic

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3
Q

Types of Mid-systolic - pathologic types?

A

Aortic stenosis
pulmonary stenosis
HOCM

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4
Q

Innocent murmur?

A 
benign
children
2-4 ICS between LSB and apex
grade 1-2
decrease or absent with sitting
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5
Q

Physiologic Murmurs?

A

similar to innocent

increased flow

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6
Q

Physiologic Murmur causes?

A

anemia
pregnancy
fever
hyperthyroidism

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7
Q

Aortic stenosis path?

A

Degenerative calcification or congenital or rheumatic ( aortic leaflets

Valve stiffens, opening narrows

Right 2nd ICS

S2 may decrease

Thrill

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8
Q

Aortic stenosis radiates to?

A

carotid

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9
Q

Aortic stenosis character and shape?

A

Harsh, crescendo-decrescendo

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10
Q

Aortic Stenosis heard best when?

A

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

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11
Q

Aortic Stenosis valsalva ?

A

↑with squatting, ↓ with standing

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12
Q

Pulmonic Stenosis patho?

A

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

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13
Q

Pulmonic Stenosis radiates to?

A

toward left shoulder or neck

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14
Q

Pulmonic stenosis character and shape?

A

Harsh quality

Crescendo-decrescendo

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15
Q

Pulmonic stenosis location?

A

2nd and 3rd left interspaces

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16
Q

HOCM path?

A

Massive ventricular hypertrophy

Sustained apical impulse

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17
Q

HOCM location?

A

3rd and 4th left interspaces

May have S3 and S4 at apex

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18
Q

HOCM radiates?

A

down LSB to apex

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19
Q

HOCM character?

A

Harsh

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20
Q

HOCM valsalva ?

A

Decreased with squatting

Increased with standing and Valsalva strain

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21
Q

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

A

increases
increases
increases

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22
Q

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

A

decreases
decreases
decreases

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23
Q

Midsystolic Click?

A

Mitral Valve Prolapse

AKA Barlow’s syndrome

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24
Q

Mitral Valve Prolapse patho?

A

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

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25
Q

Mitral Valve Prolapse pitch and shape?

A

high pitch

crescendo

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26
Q

Mitral Valve Prolapse valsalva?

A

Squatting widens (delays) the click

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27
Q

Pansystolic Murmurs ( Holosystolic)?

A

Mitral Regurgitation
Tricuspid Regurgitation
Ventricular Septal Defect

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28
Q

Mitral Regurgitation patho?

A

Mitral valve does not fully close in systole

Back flow of blood from LV to LA

Creates volume overload on LV with subsequent dilation

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29
Q

Mitral Regurgitation may develop __ at apex?

A

S3

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30
Q

Mitral Regurgitation radiates to?

A

to left axilla

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31
Q

Mitral Regurgitation is ___ louder with inspiration.

32
Q

Mitral Regurgitation pitch and character?

A

medium pitch

harsh

33
Q

Tricuspid Regurgitation patho?

A

Backward flow from RV to RA

Most commonly due to RV failure and dilatation

34
Q

Tricuspid Regurgitation location?

A

Heard along lower LSB

35
Q

Tricuspid Regurgitation radiates to ?

A

RSB and xiphoid area

36
Q

Tricuspid Regurgitation character?

37
Q

Tricuspid Regurgitation _________ with inspiration.

38
Q

Ventricular Septal Defect patho?

A

Congenital defect in intraventricular septum

Flows from LV (high pressure) to RV (low pressure)

39
Q

Ventricular Septal Defect location?

A

Left 3rd, 4th, 5th interspaces

40
Q

VSD pitch, character ?

A

Loud, thrill, harsh, high pitch

Larger defects may be quieter

41
Q

Diastolic Murmurs example?

A 
Aortic Regurgitation (early diastolic)
Mitral Stenosis (mid diastolic)
42
Q

Aortic Regurgitation patho?

A

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)

43
Q

Aortic Regurgitation location?

A

2nd to 4th L interspaces

44
Q

Aortic Regurgitation radiates to?

45
Q

Aortic Regurgitation pitch, character, and shape?

A

high to low pitch

blowing

decrescendo

46
Q

Aortic Regurgitation heard best when?

A

patient sitting leaning forward breathe held exhaled

47
Q

Mitral Stenosis patho?

A

Mitral valve thickens, stiffens or distorts from rheumatic fever

Does not fully open

May hear opening snap after S2

Accentuated S1

48
Q

Mitral Stenosis pitch and location?

A

Low pitch rumble, at apex

49
Q

Mitral Stenosis radiation?

50
Q

Mitral Stenosis shape?

A

decrescendo

51
Q

Mitral Stenosis best heard when ?

52
Q

Continuous Murmurs?

A

Venous Hum
Pericardial Friction Rub
Patent Ductus Arteriosus

Both systolic and diastolic components - all throughout the cardiac cycle and the valve no not involved

53
Q

Venous Hum patho?

A

Turbulence of flow in the jugular veins

Benign, more common in children

Can obliterate with pressure on jugular vein or by turning the head

54
Q

Venous Hum description?

A

Continuous, louder in diastole

55
Q

Venous Hum location?

A

Above medial 1/3 of clavicles, esp on R

56
Q

Is Venous Hum an Low pitch?

A

yes listen with bell

57
Q

Pericardial Friction Rub patho?

A

Inflammation of the pericardial sac

58
Q

Pericardial Friction Rub character and pitch?

A

Scratchy, high pitch

59
Q

Pericardial Friction Rub best heard when?

A

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

60
Q

Pericardial Friction Rub location?

A

best heard at 3rd ICS, LSB

61
Q

Patent Ductus Arteriosus patho?

A

Congenital opening between the aorta and pulmonic artery. Should have closed at birth

Loudest in late systole (obscures S2)

May have a thrill

62
Q

Patent Ductus Arteriosus location?

A

Left 2nd ICS

63
Q

Patent Ductus Arteriosus radiates to?

A

toward left clavicle

64
Q

Patent Ductus Arteriosus character ?

A

Harsh, Machinery like

65
Q

Acute Coronary Syndrome (ACS) patho?

A

Any syndrome caused by acute myocardial ischemia

Associated with a friction rub

66
Q

Acute Coronary Syndrome (ACS) results in?

A

unstable angina
NSTEMI
STEMI

67
Q

Pericarditis patho?

A

Retrosternal chest pain - right in the middle

Sharp!

68
Q

Pericarditis is _____ with position changes, cough

A

worse

angina does not change with position changes

69
Q

Pericarditis is ______ with sitting up and leaning forward.

70
Q

Aortic Dissection patho?

A

blood in false lumen

anterior chest pain radiating to back or neck

Tearing ripping

severe or acute

71
Q

What is Cardiac Tamponade?

A

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

72
Q

Heart Failure patho?

A

Diastolic or systolic dysfunction

Often results in fluid overload

73
Q

Heart Failure symptoms ?

A

Dyspnea

Orthopnea

Paroxysmal nocturnal dyspnea

Edema (dependent)

DOPE

74
Q

Heart Failure JVP and HJR results?

A

Increased JVP and positive HJR

S3 and S4 too

75
Q

Hypertension chronic will displace the PMI _________. - LVH.

A

laterally

Sustained, bounding pulse

Patient Evaluation (29 decks)

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