murmurs Flashcards
underlying RHD fatigue, exertional dyspnea, orthopnea hoarseness (partners syndrome) edema, ascites with pulmonary HTN A fib, systemic thromboembolism
Hx MS
malar flush precordial bulge RV heave with pulmonary HTN Loud S1 opening snap following S2
MS
apical mid diastolic rumble
decrescendo-cresendo
presynaptic accentuation
best heard after exercise, using bell at apex with the pt on left lateral position
MS
terminal component missing in A fib and also A wave and S4
MS
aortic root dilation: marfans and syphilis
post infection: RHD, inf endocarditis
structural: bicuspid aortic valve (age <65) and aortic dissection
AR
heart failure
acute: rapidly developing HF
chronic: long standing asymptomatic; chronic volume overload - LV dysfxn
AR
S1 normal or diminished
S3
AR
decrescendo
diastolic
loudest alond Erb point when leaning forward on full expiration
AR
low pitched mid diastolic apical
“fxn MS”
anterior leaflet of MV vibrates at same time as blood jets from left atrium and the aorta
Austin flint murmur
water hammer quick to rise and collapse
corrigans
visible pulsations of retinal arterioles and pupils
beckers
head bobbing synchronous with heartbeat
de Mussets
systolic and diastolic bruit when femoral artery is compressed
duroziez
popliteal cuff systolic pressure > brachial pressure by 40 mmHg
hills
pulsatile nailbeds
pink white pink white
quinckes
congenital bicuspid aortic valve less than 65 yo
degenerative or senile calcific AS over 65 yo
AS
risk factors: HTN, hypercholesterolemia, smoking
Hx: syncope, angina, dyspnea on exertion
AS
sustained, powerful, heaving PMI to left and slightly below MCL
delayed and diminished carotid pulse (pulses parvus et tardus)
AS
paradoxical split S2
single/soft S2
S4
Ej. click: bicuspid AV or flexible stenosis
AS
harsh, systolic, ej. type (diamond)
R 2nd ICS (heard best) parasternal with radiation to carotids
AS
passive leg raising increase murmur
standing decrease murmur
AS
increase in after load incomplete emptying of LA LV hypertrophy decrease CO RV strain pulmonary congestion
AS
acute: abrupt increase LA pressure
chronic: LA enlarges progressively
MR
widely split S2
S3 indicates severity
MR
holosystolic, blowing, high pitched loudest over apex
radiates to L axilla
MR
myxomatous degeneration of MV
1) malcoaptation of MV leaflets during systole - regurg
2) young pmts - gross redundancy of both the anterior and posterior leaflets and chordal apparatus
3) older pts - fibroelastic def
connective tissue dz
1) marfans, Ehlers danlo, osteo imperfecta
2) ASD
MVP
apical systolic (non ej) click followed by a MR murmur (heard best at apex)
MVP
1) passive leg raising/squatting
increase VR - increase LV size and volume - click = later
2) after sudden standing/ valsalva
decrease VR - decrease LV size and volume - clicks = earlier
MVP
