Murmurs Flashcards

1
Q

Jugular venous pressure is equal to

A

Right atrium pressure

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2
Q

What is the difference between the jugular venous pulsations and the carotid impulses?

A

Jugular pulsations are biphasic

Carotic impulses are monophasics

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3
Q

What are the two major upward components of the jugular venous pulsation?

A

Pressure from right atrium contraction

Passive filling of the right atrium during systole (when tricuspid valve is closed)

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4
Q

On the jugular venous pulsation graph, why does the pressure still drops after the tricuspid valves close?

A

The atrium gets bigger even if the valves are closes, diminishing the pressure

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5
Q

By what is produced the first heart sound S1?

A

By the closure of the mitral and tricuspid valves

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6
Q

By what is produced the second heart sound S2?

A

Closure of the aortic and pulmonary valves

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7
Q

What are ejection clicks?

A

Abnormal sharp high-pitched early systolic sounds coinciding with the opening of the aortic or pulmonary valves

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8
Q

Ejection clicks can indicate what (3)?

A

Congenital aortic stenosis
Pulmonic valve stenosis
Dilatation of the pulmonary artery or aorta

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9
Q

Non-ejection clicks can indicate what?

A

Systolic prolapse of the mitral or tricuspid valves

Often accompanied by valvular regurgitation

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10
Q

What are the extra-diastolic heart sounds (4)?

A

Opening snap
S3
S4
Pericardial knock

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11
Q

What is the “opening snap”

A

Crisp sounds after S2

Corresponds to the opening of the mitral and tricuspid valves (which are normally silent)

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12
Q

Opening snap is indicative of what?

A

Mitral or tricuspid stenosis

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13
Q

The S3 sound is indicative of what?

A

Tensing of the chordea tendineae. Occurs in early diastole during ventricular rapid filling phase.

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14
Q

When is S3 sound is normal?

A

In children and young adults

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15
Q

S3 sound is indicative of what is adults?

A

Dilated ventricle

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16
Q

S4 sound coincide with what?

A

Contraction of the atria

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17
Q

Can you hear S4 when there’s atrial fibrillation?

A

Non. There’s no contraction of the atria

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18
Q

What does S4 sound indicate?

A

Decrease in ventricular compliance (ventricular hypertrophy of myocardial ischemia)

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19
Q

By what is generated the S4 sound?

A

By left atrium ejecting blood in stiffened ventricular

20
Q

By what is produce a murmur?

A

By turbulent flow

21
Q

A murmur can be caused by five mechanisms. What are they?

A

Flow across stenosis
Increased flow through normal structures
Ejection in dilated chamber
Regurgitant flow across an incompetent valve (mitral regurgitation)
Abnormal shunting of blood from one vascular chamber to a lower-pressure chamber

22
Q

What is grade 1/6 of murmur intensity?

A

Barely audible

23
Q

What is grade 3/6 of murmur intensity?

A

Easily heard

24
Q

What is grade 4/6 of murmur intensity?

A

Easily heard + thrill

25
What is grade 6/6 of murmur intensity?
Audible without a stethoscope
26
A high-pitch murmur is indicative of what?
Caused by large pressure gradients between chambers
27
Mitral regurgitation murmur radiates where?
Axilla (armpit)
28
What are the three systolic murmurs?
Systolic ejection murmur Pansystolic/Holosystolic murmur Late systolic murmur
29
What are the characteristics of systolic ejection murmur?
Between S1 and S2 (during ejection) | Crescendo-decrescendo
30
Systolic ejection murmur is typical of what?
Aortic/pulmonic stenosis
31
What are innocent murmurs?
Same sound as systolic ejection murmur, but disappear when patient sits upright. Results from increase systolic flow across normal aortic/pulmonic valves
32
Pansystolic/Holosystolic murmur is caused by what (2)?
Regurgitation of blood across incompetent mitral or tricuspid valve Flow through a ventricular septal defect
33
Why is there no delay between S1 and pansystolic murmur?
Because when ventricular systolic pressure exceeds atrial pressure (S1), there's immediate retrograde flow across the regurgitant valve (murmur)
34
Does pansystolic murmur of advanced mitral regurgitation continues through aortic closure (S2)?
Yes
35
Does mitral valve regurgitation murmur intensity increase with respiration?
No
36
Does tricuspid valve regurgitation murmur intensity increase with respiration?
Yes
37
Where does tricuspid valve regurgitation murmur radiate?
To the right sternum
38
What is the quality of the murmur of ventricular septal defect
High-pitch, thrill | The smaller the defect, the louder the murmur
39
Late-systolic murmur is a sign of what?
Mitral valve prolapse
40
What are the two types of diastolic murmurs?
Early decrescendo murmur | Mid-to-late rumbling murmur
41
Early decrescendo murmur increases with respiration. It is a sign of what?
Pulmonic regurgitation
42
Early decrescendo murmur is a sign of what (2)?
Pulmonic regurgitation | Aortic regurgitation
43
Mid-to-late rumbling murmur is a sign of what?
Turbulent flow across a stenotic mitral or tricuspid valve
44
Continuous murmur is a result of what?
Persistent pressure gradient between two structures during systole and diastole
45
Continuous murmur can be a sign of which congenital disease?
Patent ductus arteriorus
46
Which murmur is characterized by crescendo-decrescendo-decrescendo (yes yes) and often confused with continuous murmur?
To-and-Fro murmur