Murmurs/Cardiomyopathies Flashcards
Murmurs are graded 1-6. What is grade 3?
Murmur is louder than S1 and S2
Murmurs are graded 1-6. What is grade 4?
A palpable thrill is present
Murmurs are graded 1-6. What is grade 5 and 6?
5 = Heard with stethoscope half off chest
6 = Heard without stethoscope
What 2 types of murmurs should be further evaluated?
- ANY diastolic murmur
- Systolic murmurs that are 3+ grade
What 2 types of murmurs should be further evaluated?
- ANY diastolic murmur
- Systolic murmurs that are 3+ grade
Certain murmurs become louder with more blood in the heart, what are 2 maneuvers to do this?
- Leg lift
- Squatting
A majority of the murmurs will become louder with?
More blood in the heart
– leg lift or squatting
What often causes Mitral Stenosis?
Rheumatic heart disease
What will be heard with Mitral Stenosis?
Opening snap and diastolic rumble at the apex
What is the unique treatment for Mitral Stenosis?
Balloon valvuloplasty
What often causes Regurgitation murmurs?
Infection
Infarction
What will be heard with Mitral Regurgitation?
Holosystolic murmur at the apex
What can cause Mitral Regurgitation?
Rupture of chordae/papillae muscles
What can cause Aortic Regurgitation?
Aortic Dissection
What will be heard with Aortic Regurgitation?
Decrescendo rumbling diastolic murmur
What often causes Aortic Stenosis?
Calcified valve from atherosclerosis/bicuspid valve
What will be heard with Aortic Stenosis?
Crescendo-Decrescendo systolic murmur that radiates to the carotids
What is the treatment for Mitral Regurgitation and both Aortic murmurs?
Valve replacement
Certain murmurs become louder with less blood in the heart. How is this done?
Valsalva
What murmurs will become louder with valsalva (less blood in the heart)?
HOCM
MVP
What murmurs will become softer/better with more blood in the heart (leg lift/squat)?
HOCM
MVP
What are the presenting signs of HOCM?
Young athlete with dyspnea or syncope on exertion
– (+) family history often
What causes HOCM?
Sarcomere dysfunction that leads to septal hypertrophy and LV outflow obstruction
What will be heard with HOCM?
Aortic Stenosis murmur
= Crescendo-Decrescendo systolic murmur
What is the treatment for HOCM?
Beta blocker and maintain hydration
What often causes MVP?
Congenital – seen in young women
What will be heard with MVP?
Holosystolic murmur
= Mid-systolic click
What is the treatment for MVP?
Beta blocker and maintain hydration
With Dilated Cardiomyopathy, the chambers of the heart will be dilated with thin walls. What are some possible etiologies?
Virus
Alcohol
Ischemia
What often causes Concentric Hypertrophy?
Hypertension
What are 3 possible causes of Restrictive Cardiomyopathy?
- Amyloid
- Sarcoid
- Hemachromatosis
What are 3 possible causes of Restrictive Cardiomyopathy?
- Amyloid
- Sarcoid
- Hemachromatosis
If Amyloid is causing Restrictive Cardiomyopathy, what else may be present? How do you begin to diagnose?
- Peripheral Neuropathy
==> Fat pad/gingival biopsy
If Sarcoid is causing Restrictive Cardiomyopathy, what else may be present?
How do you begin to diagnose?
- Lung disease
==> Cardiac MRI with endomyocardial biopsy
If Hemachromatosis is causing Restrictive Cardiomyopathy, what else may be present?
How do you begin to diagnose?
- Bronze DM or Cirrhosis
==> Ferritin level and genetic screen
HOCM and MVP will improve with what maneuvers?
More blood in the heart
= Leg lift or squat
HOCM and MVP will worsen with what maneuvers?
Less blood in the heart
= Valsalva
With Right sided HF, blood backs up into the IVC/SVC. What are some symptoms?
JVD
Hepatosplenomegaly
Peripheral edema
With Left sided HF, blood backs up into the lungs. What are some symptoms?
Dyspnea on exertion
Orthopnea
Paroxysmal Nocturnal Dyspnea
3 tests to order for evaluation of HF?
- BNP
- Echo
- Left heart cath
3 tests to order for evaluation of HF?
- BNP
- Echo
- Left heart cath
What is the initial treatment for HF? (2)
Beta blocker
ACEi
What is the initial treatment for HF? (2)
Beta Blocker
ACEi
Following Beta blocker and ACEi, what can be added to treat HF?
Loop Diuretic
Following Beta blocker, ACEi, Diuretic, what can be added to treat HF?
Spironolactone or Isosorbide-Hydralazine
Last medication to add for late HF?
Inotrope – ex. Dobutamine
For a HF exacerbation, what is the pneumonic for treatment?
LMNOP
= Lasix, Morphine, Nitrate, Oxygen, Position
Treatment for HF exacerbation?
LMNOP
= Lasix, Morphine, Nitrate, Oxygen, Position
With a Systolic dysfunction, what causes it? Expected EF?
LV is thin/atrophied and unable to contract
** EF = < 50% (LOW)
With a Diastolic dysfunction, what causes it?
Expected EF?
LV is hypertrophied and unable to relax and fill
** EF = > 50% (Normal/HIGH)
