Murmurs

Question 1

what are some causes of Aortic stenosis?

Answer 1

CAD, congenital, rheumatic fever

Question 2

What are the physical exam findings of aortic stenosis?

Answer 2

RT second interspace. Harsh crescendo/decrescendo mid systolic murmur w/ radiation to the RT neck.

Question 3

What are some chief complaints of pts w/ aortic stenosis?

Answer 3

Exertional dyspnea, SOB, syncope, exertional angina

Question 4

In what position should the patient be in to best appreciate an aortic stenosis murmur?

Answer 4

Sitting up in tripod position.

Question 5

What diagnostic tests should you order for aortic stenosis?

Answer 5

Echo is gold standard.
ECG, which may show left ventricular hypertrophy (think why?)
CXR, which may show calcified aortic valve

Question 6

What medications would you use to treat aortic stenosis and why?

Answer 6

Treat angina w/ beta blockers and CCBs
Treat HTN but no systemic vasodilators.
AVOID NITRATES DUE TO RISK OF SEVERE HYPOTENSION.
NO SYSTEMIC VASODILATORS b/c you already aren’t getting enough blood out to the system. Person can not compensate.

Question 7

What are some causes of aortic regurgitation/insufficiency?

Answer 7

SCREAM
Syphilis
Congenital
Rheumatic fever
Endocarditis
Aortic root dilation
Marfans

Question 8

What are some common SSx of aortic insufficiency/regurgitation?

Answer 8

Exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations

Question 9

Where is an aortic regurgitation/insufficient murmur heard and what does it sound like?

Answer 9

LT 2nd ICS; early diastolic decrescendo; heard best in tripod position.

Question 10

Will valsalva increase or decrease the murmur?

Answer 10

Increase b/c it increase venous return

Question 11

What diagnostic studies should you order for aortic regurgitation/insufficiency?

Answer 11

ECHO
ECG: May show left ventricular hypertrophy
CXR:
Cardiac Cath

Question 12

Txt for aortic regurgitation/insufficiency.

Answer 12

HTN control focusing on decreasing afterload

Valve replacement

Question 13

If you hear a machinery-like murmur at the left sternal border, this should make you think of what diagnosis?

Answer 13

Patent ductus arteriosis.

Question 14

Left to right shunting from the left atrium to the right atrium should make you think of what defect?

Answer 14

Atrial septal defect (aka patent foramen ovale)

Question 15

Left to right shunting from the left ventricle to the right ventricle should make you think of what defect?

Answer 15

Ventricular septal defect

Question 16

Holosystolic murmur heard at the apex that radiates to the back

Answer 16

Mitral regurgitation

Question 17

harsh crescendo-decrescendo midsystolic murmur, which radiates to carotid arteries.

Answer 17

Aortic stenosis

Question 18

blowing holosystolic murmur best heard at the right or left mid sternal border or at the subxiphoid area and increases with inspiration.

Answer 18

Tricuspid regurgitation

Question 19

harsh, blowing holosystolic murmur that may be associated with a thrill.

Answer 19

Ventricular septal defect

Question 20

Harsh, blowing pansystolic murmur at the apex

Answer 20

Mitral regurgitation