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Cardiology (inpatient) > Paine Podcast murmurs > Flashcards

Paine Podcast murmurs Flashcards

1
Q

Aortic Stenosis Causes

A

1) Congenitally abnormal valve (bicuspid)
2) Calcific disease –> most common in US
3) Rheumatic valve disease –> most common world wide

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2
Q

AS triad sx

A

1) Dyspnea on exertion
2) Exertional dizziness or syncope
3) Angina

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3
Q

AS description

A

+ high pitched, crescendo-decrescendo (diamond shaped) midsystolic murmur

+ soft s2

+s4 may be present

+ often with a loud thrill

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4
Q

AS auscultation point

A

2cd R ICS

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5
Q

AS special notes

A

radiates to carotid arteries

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6
Q

AR causes

A

1) aortic root dilation (retrgrades tears it up)
2) congenital bicuspid valve
3) calcific dz
4) rheumatic heart dz (most common world wide)

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7
Q

What does AR result in?

A

volume overloading due to the retrograde flow into the left ventricle

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8
Q

signs and sx of AR

A

+ exertional angina and dyspnea

+ sx of HF: PND, orthopnea, pulmonary edema, lower extremity edema

+crackles (rales)

+laterally and inferiorly displaced pMI with a thrill

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9
Q

description of AR

A

+ soft, high-pitched, early diastolic decrescendo murmur

+soft S1 with soft/absent s2

+S3 may be present depending on degree of heart failure

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10
Q

best auscultaion position for AR

A

L 3rd ICS (erbs)

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11
Q

speical note for AR

A

accentuated by pt sitting up and leaning forward at end expiration

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12
Q

mitral stenosis top causes

A

1) Rheumatic heart dz
2) mitral annular calcification
3) radiation associated-valve disease (Hodgkin’s lymphoma)

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13
Q

MS signs and sx

A

+exertional dyspnea
+decreased exercise tolerance
+hemoptysis (increased pulmonary pressure)
+angina
+fatigue
+ atrial fibrillation (elevated left artial pressure)S2

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14
Q

MS description

A

opening snap w/ low pitched diastolic murmur

+decrescendo after S2

+late, diastolic, crescendo before S1

+ loud S1

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15
Q

MS best auscultation positions

A

cardiac apex at left 5th intercostal space, midclavicular line

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16
Q

MS pitch and quality

A

low pitch, best heard with bell

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17
Q

special notes for MS

A

best heard w/ pt in left lateral decubitus in held expiration

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18
Q

MR causes

A

1) primary:
+degenerative mitral valve dz (most common in US)- mitral valve prolaps
+Rheumatic Heart dz

2) Secondary
+CAD (regional wall motion abnormality)

+dilated CMP
+Hypertrophic CMP

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19
Q

sx of MR

A

exertional dyspnea

fatigue
+afib
+heart failure

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20
Q

MR description

A

high-pitched “blowing”, holosystolic murmur

+diminished S1

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21
Q

MR best auscultation point

A

+cardica apex at left 5th intercostal space, midclavicular line

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22
Q

special notes for MR

A

+radiates to axilla
+no variability in respiration

+decreases in intensity with valsalva

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23
Q

MVP causes

A

1) primary
+sporadic (myxomatous degenerations)
+familial (autosomal dominant with incomplete penetrations: 30-50% in first degree releative)

2) secondary
+ connective tissue disorders
+infective endocarditis
+CAD

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24
Q

signs and sx of MVP

A 
\+palpitations
\+dyspnea
\+exercise intolerance
\+ panic and anxiety disorders
\+ numbness or tingling
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25
Q

what is myxomatous degenerations

A

deterioration of connective tissues in certain parts of the body

26
Q

description of MVP

A

midsystolic click followed by a uniform, high-pitched, late systolic murmur

27
Q

best ascultation of MVP

A

apex

28
Q

special notes for MVP

A

responds to dynamic auscultation
+increased in sudden standing
+decreased in sudden dquating

29
Q

Tricuspid stenosis causes

A

1) Rheumatic heart dz
2) atrial myxoma
3) carcinoid syndrome

30
Q

what is carcinoid syndrome?

A

The syndrome includes flushing and diarrhea, and less frequently, heart failure, emesis and bronchoconstriction. It is caused by endogenous secretion of mainly serotonin and kallikrein.

31
Q

s/sx of TS

A

+abdominal discomfort (hepatic congestion and hepatomegaly)

+fluttering sensation in neck caused by JVP

+JVD, ascites, peripheral edema

32
Q

TS descriptions

A

soft, high-pitched, mid-diastolic

33
Q

what is the best asucultation point for TS

A

4th intercostal space on sternal border

34
Q

special notes for TS

A

increased during inspiration, squatiing or leg raise

35
Q

TR causes

A

1) functional: dilation of RA and ventricle w/dilation of tricuspid annular leaflet (pulm HTN, Left sided heart failure, left to right shunt

2) valvular
- valve damage from pacemaker or ICD
- Infective endocarditis
- rheumatic heart dz
- ischemic heart dz

36
Q

S/sx of TR

A
  • majority are asxymptomatic

- Right sided heart failure: hepatomegaly, hepatic congestion, ascities, heptic venous hum, JVd,edema

37
Q

description of TR

A

high-pitched, holosystolic murmur

38
Q

best auscultation position for TR

A

4th LLSB,

39
Q

where does TR radiate to?

A

right sternum, xiphoid

40
Q

what can be done to hear TR better?

A

increased with inspiration, leg raises, or squatting

41
Q

pulmonic stenosis causes

A

1) congenital (10% of children w/ congenital heart dz): TOF, noonan syndrome
2) bicuspid valves
3) calcification

42
Q

s/sx of PS

A
  • exertional dyspnea

- right heart failure

43
Q

description of Ps

A

-midsystolic, high-pitched, crescendo-decrescendo

  • pulmonary ejection click
  • extends through the A2
  • split S2
44
Q

best auscultation point for PS

A

2-3rd LICS

45
Q

special notes for PS

A

-increased during inspirations

46
Q

Pulmonic regurg causes

A

1) primary: iatrogenic, infectious, rheumatic, congenital
2) pulmonary artery hypertension and or dilation
3) physiologic

47
Q

PR s/s

A

asx until right ventricular dysfxn occures

  • exertional dyspnea, fatigue
  • tacyarrythmias
48
Q

description of PR

A

soft, high-pitched, early diastolic decrescendo

-graham-steele murmur (pulmonary HTN): high-pitched, blowing with accentuated P2

49
Q

best ausculatation point for PR

A

left 2 ICS

50
Q

what can be done to help one hear PR?

A

increased with inspirations

51
Q

what causes an S3

A

large amonut of blood hitting an very compliant LV (systolic heart failure)

best heart at apex

+ventricular gallop

52
Q

S3 decription

A

Ken—-tuck-y

occures after S2

53
Q

S4 cuases

A

Blood striking a non-compliant left ventricle

Diastolic heart failure, LVH

54
Q

S4 description

A

Ten-nes—-see

apex , late diastolic murmu

55
Q

what will you hear at the tricuspic area? (4-5 LICS)

A

Pansystolic: Tricuspid R, VSD

mid-to late diastolic: TS, ASD

56
Q

what will you hear at aortic area? (2 RICS)

A

ejection type murmur: AS, flow murmur

57
Q

what will you heart at pulmonic area (2 LICS)

A

ejection type: PS

58
Q

what will you heart ate left sternal border/ erbs point

A

AR, PR (late diastolic)

59
Q

what will you hear at mitral area? (aka apex)

A

pansystolic: MR

mid-to-late diastolic: MS

60
Q

what are the diastolic murmuers?

A

AR, PR, MS

61
Q

what are the systolic murmurs

A

mr. taps

62
Q

what are the pansystolic murmurs?

A

MR, TR

Cardiology (inpatient) (14 decks)

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