Murmurs Flashcards
Jugular venous pressure is equal to
Right atrium pressure
What is the difference between the jugular venous pulsations and the carotid impulses?
Jugular pulsations are biphasic
Carotic impulses are monophasics
What are the two major upward components of the jugular venous pulsation?
Pressure from right atrium contraction
Passive filling of the right atrium during systole (when tricuspid valve is closed)
On the jugular venous pulsation graph, why does the pressure still drops after the tricuspid valves close?
The atrium gets bigger even if the valves are closes, diminishing the pressure
By what is produced the first heart sound S1?
By the closure of the mitral and tricuspid valves
By what is produced the second heart sound S2?
Closure of the aortic and pulmonary valves
What are ejection clicks?
Abnormal sharp high-pitched early systolic sounds coinciding with the opening of the aortic or pulmonary valves
Ejection clicks can indicate what (3)?
Congenital aortic stenosis
Pulmonic valve stenosis
Dilatation of the pulmonary artery or aorta
Non-ejection clicks can indicate what?
Systolic prolapse of the mitral or tricuspid valves
Often accompanied by valvular regurgitation
What are the extra-diastolic heart sounds (4)?
Opening snap
S3
S4
Pericardial knock
What is the “opening snap”
Crisp sounds after S2
Corresponds to the opening of the mitral and tricuspid valves (which are normally silent)
Opening snap is indicative of what?
Mitral or tricuspid stenosis
The S3 sound is indicative of what?
Tensing of the chordea tendineae. Occurs in early diastole during ventricular rapid filling phase.
When is S3 sound is normal?
In children and young adults
S3 sound is indicative of what is adults?
Dilated ventricle
S4 sound coincide with what?
Contraction of the atria
Can you hear S4 when there’s atrial fibrillation?
Non. There’s no contraction of the atria
What does S4 sound indicate?
Decrease in ventricular compliance (ventricular hypertrophy of myocardial ischemia)
By what is generated the S4 sound?
By left atrium ejecting blood in stiffened ventricular
By what is produce a murmur?
By turbulent flow
A murmur can be caused by five mechanisms. What are they?
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
What is grade 1/6 of murmur intensity?
Barely audible
What is grade 3/6 of murmur intensity?
Easily heard
What is grade 4/6 of murmur intensity?
Easily heard + thrill
What is grade 6/6 of murmur intensity?
Audible without a stethoscope
A high-pitch murmur is indicative of what?
Caused by large pressure gradients between chambers
Mitral regurgitation murmur radiates where?
Axilla (armpit)
What are the three systolic murmurs?
Systolic ejection murmur
Pansystolic/Holosystolic murmur
Late systolic murmur
What are the characteristics of systolic ejection murmur?
Between S1 and S2 (during ejection)
Crescendo-decrescendo
Systolic ejection murmur is typical of what?
Aortic/pulmonic stenosis
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
Pansystolic/Holosystolic murmur is caused by what (2)?
Regurgitation of blood across incompetent mitral or tricuspid valve
Flow through a ventricular septal defect
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)
Does pansystolic murmur of advanced mitral regurgitation continues through aortic closure (S2)?
Yes
Does mitral valve regurgitation murmur intensity increase with respiration?
No
Does tricuspid valve regurgitation murmur intensity increase with respiration?
Yes
Where does tricuspid valve regurgitation murmur radiate?
To the right sternum
What is the quality of the murmur of ventricular septal defect
High-pitch, thrill
The smaller the defect, the louder the murmur
Late-systolic murmur is a sign of what?
Mitral valve prolapse
What are the two types of diastolic murmurs?
Early decrescendo murmur
Mid-to-late rumbling murmur
Early decrescendo murmur increases with respiration. It is a sign of what?
Pulmonic regurgitation
Early decrescendo murmur is a sign of what (2)?
Pulmonic regurgitation
Aortic regurgitation
Mid-to-late rumbling murmur is a sign of what?
Turbulent flow across a stenotic mitral or tricuspid valve
Continuous murmur is a result of what?
Persistent pressure gradient between two structures during systole and diastole
Continuous murmur can be a sign of which congenital disease?
Patent ductus arteriorus
Which murmur is characterized by crescendo-decrescendo-decrescendo (yes yes) and often confused with continuous murmur?
To-and-Fro murmur
