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Step2CK > murmurs > Flashcards

murmurs Flashcards

1
Q

mitral stenosis etiology

A

rhematic fever

immune mediated damage to mitral valve leading to fish mouth shaped orifice

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2
Q

mitral stenosis pressure

A

increased LA pressure (and size)
increased pulmonary venous pressure

leads to pulmonary congestion

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3
Q

mitral stenosis exacerbation

A

anything that increases flow across mitral valve: exercise, tachy

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4
Q

mitral stenosis long term (2)

A 
pulomnary HTN (leading to RHF)
A fib due to increase LA size and pressure
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5
Q

mitral stenosis symptoms

A

exertional dyspnea, orthopnea, PND
palpitations
hemoptysis

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6
Q

mitral stenosis murmur

A

low pitched DIASTOLIC rumble with S2 followed by opening snap
closer S2 and opening snap = worse
Loud S1

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7
Q

mitral stenosis tx

A

beta blocker: decrease HR and CO
diuretics for pulm congestion and edema
balloon valvuloplasty

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8
Q

aortic stenosis etiology

A

calcification of valve - early in abnl bicuspid, later for tricuspid
rheumatic fever

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9
Q

aortic stenosis remodeling

A

increased LV hypertrophy, causing obstruction to LV outflow

late: increaed LV, LA

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10
Q

aortic stenosis severe

A

CO decreases causing angina with exertion
LV dilation and dysfunction
pulls apart mitral valve annulua apart, causing MR

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11
Q

aortic stenosis symptoms

A

angina, syncope or HF

many are asymptomatic

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12
Q

aortic stenosis murmur

A

hard cresendo-decresendo SYSTOLIC murmur radiating to carotids
softer with valsalva - less flow across valve
second right intercostal space
soft S2
parvus et tardus: delayed carotid upstrokes (weak and slow rising carotid pulse)
precordial thrill

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13
Q

aortic stenosis tx

A

valve replacement is treatment of choice

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14
Q

aortic regurg etiology

A

inadequate closure of aortic valve causing regurg blood flow into LV
infective endocarditis, trauma, aortic dissection
bicuspid valve, marfan, ehlers-danlos, ankylosing spondylitis, SLE
syphilitic aortisis, osteogenica imperfecta

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15
Q

aortic regurg pressure

A

LV dilation and hypertrophy to maintain stroke volume and prevent diastolic pressure from increasing
Increased LV end diastolic volume and pressure, leading to pulmonary congestion
Causing increased LV and pulmonary pressures (late)

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16
Q

aortic regurg murmur

A

DIASTOLIC decresendo murmur

INCREASES with increased SVR, eg handgrip, causes backflow through incompetent valve

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17
Q

aortic regurg symptoms

A

dysnea on exertion, PND, orthopnea
palpitations, angina
cyanosis and shock in acute AR
widened pulse pressure (high SBP with low DBP)
water hammer pulse : rapidly increasing pulse that decreases in late systole
displaced PMI

18
Q

handgrip effect, squatting

A

increases SVR

19
Q

aortic regurg tx

A 
afterload reduction (salt restriction, ACEi, arterial dilators), vasodilators, salt restriction
Surgery is definative
Acute AR: medical emergency, emergent replacement
20
Q

mitral regurg etiology

A

acute: endocarditis (staph a), papillary muscle rupture, chordae tendineae rupture, inferior MI with papillary muscle displacement
chronic: MVP, rheumatic fever, marfan, cardiomyopathy

21
Q

mitral regurg pressure - acute

A

increase in LA pressure with normal LA size and compliance causing back flow into pulomnary circ leading to acute pulm edema
increased LV end diastolic volume and filling pressure
decreased CO with hypotension and shock

22
Q

mitral regurg pressure - chronic

A

gradual elevation of LA pressure in setting of dialted LA and LV with increased LA compliance
LV dysfunction
pulm htn from chronic backflow

23
Q

mitral regurg murmur

A

HOLOSYSTOLIC at apex radiates to axilla

soft S1, wide S2, S3 gallop

24
Q

mitral regurg tx

A

afterload reduction with vasodilators

valve replacement or repair before LV dilates too much

25
Q

mitral regurg sympotoms

A

dysnea on exertion, PND
palpitations
pulm edema
Afib

26
Q

tricuspid regurg etiology

A

usu RV dilation, due to LV failure, RV infarction, inferior wall MI, cor pulmonale, pulm HTN
endocarditis in IVDU
epstein anomoly - downward displacement of valve into RV

27
Q

tricuspid regurg symtpoms

A

usu asymp, signs of RVF (ascities, hepatomegaly, edema, JVD), pulsitile liver
afib

28
Q

tricuspid regurg mumur

A

Blowing holosystolic at LLSB

louder with inspiration, reduced with expiration or valsalva

29
Q

valsalva effect, standing

A

reduces preload, reduces LV size
increases HOCM and MVP
decreases AS, pulmonic stenosis, and triC regurg

30
Q

MVP etiology

A

myxomatous degeneration of valve leaflet or chordae tendineae
Marfan, osteogenesis imperfecta, Ehlers Danlos
most common cause of MR in developed countries

31
Q

MVP symptoms

A

most asymp, palpitations and chest pain

rare TIA

32
Q

MVP murmur

A

Mid-late SYSTOLIC murmur, with mid systolic click
increses with standing and valsalva because LV size is reduced allowing murmur and click to occur sooner
squatting decreases because LV size is increased

33
Q

MVP tx

A

usu nothing, beta blockers for chest pain

34
Q

HOCM murmur (intraventricular septal hypertrophy)

A

(cresendo-decresendo) SYSTOLIC ejection murmur without carotid radiation
louder with valsava - less blood to push wall apart
softer with handgrip, squating - more blood to push walls apart

35
Q

VSD murmur

A

holosystolic with LATE diastolic rumble

can see LV overload, and pum htn from increased RV volumes

36
Q

PDA murmur

A

communication iwth aorta and pulmonary artery
continuous machine like murmur
rubella
closure - indomethacin
patent - prostaglandin during transposition

37
Q

ASD murmur

A

wide split S2 and soft mid systolic at LUSB

increased flow across pulmonary vasculature

38
Q

coarctation of aorta

A

narrowing of constriction of aorta
HTN in UE, with hypotension in LE
midsystolic murmur heard in back
figure of 3

39
Q

nitrates

A

vasodilate, decrease LV volume, wall stress

40
Q

Tetralogy of fallot

A

Harsh Crescendo descendo systolic murmur at left upper eternal Border with single s2

Step2CK (11 decks)

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