Paine Podcast murmurs Flashcards
Aortic Stenosis Causes
1) Congenitally abnormal valve (bicuspid)
2) Calcific disease –> most common in US
3) Rheumatic valve disease –> most common world wide
AS triad sx
1) Dyspnea on exertion
2) Exertional dizziness or syncope
3) Angina
AS description
+ high pitched, crescendo-decrescendo (diamond shaped) midsystolic murmur
+ soft s2
+s4 may be present
+ often with a loud thrill
AS auscultation point
2cd R ICS
AS special notes
radiates to carotid arteries
AR causes
1) aortic root dilation (retrgrades tears it up)
2) congenital bicuspid valve
3) calcific dz
4) rheumatic heart dz (most common world wide)
What does AR result in?
volume overloading due to the retrograde flow into the left ventricle
signs and sx of AR
+ exertional angina and dyspnea
+ sx of HF: PND, orthopnea, pulmonary edema, lower extremity edema
+crackles (rales)
+laterally and inferiorly displaced pMI with a thrill
description of AR
+ soft, high-pitched, early diastolic decrescendo murmur
+soft S1 with soft/absent s2
+S3 may be present depending on degree of heart failure
best auscultaion position for AR
L 3rd ICS (erbs)
speical note for AR
accentuated by pt sitting up and leaning forward at end expiration
mitral stenosis top causes
1) Rheumatic heart dz
2) mitral annular calcification
3) radiation associated-valve disease (Hodgkin’s lymphoma)
MS signs and sx
+exertional dyspnea
+decreased exercise tolerance
+hemoptysis (increased pulmonary pressure)
+angina
+fatigue
+ atrial fibrillation (elevated left artial pressure)S2
MS description
opening snap w/ low pitched diastolic murmur
+decrescendo after S2
+late, diastolic, crescendo before S1
+ loud S1
MS best auscultation positions
cardiac apex at left 5th intercostal space, midclavicular line
MS pitch and quality
low pitch, best heard with bell
special notes for MS
best heard w/ pt in left lateral decubitus in held expiration
MR causes
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
sx of MR
exertional dyspnea
fatigue
+afib
+heart failure
MR description
high-pitched “blowing”, holosystolic murmur
+diminished S1
MR best auscultation point
+cardica apex at left 5th intercostal space, midclavicular line
special notes for MR
+radiates to axilla
+no variability in respiration
+decreases in intensity with valsalva
MVP causes
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
signs and sx of MVP
\+palpitations \+dyspnea \+exercise intolerance \+ panic and anxiety disorders \+ numbness or tingling
what is myxomatous degenerations
deterioration of connective tissues in certain parts of the body
description of MVP
midsystolic click followed by a uniform, high-pitched, late systolic murmur
best ascultation of MVP
apex
special notes for MVP
responds to dynamic auscultation
+increased in sudden standing
+decreased in sudden dquating
Tricuspid stenosis causes
1) Rheumatic heart dz
2) atrial myxoma
3) carcinoid syndrome
what is carcinoid syndrome?
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.
s/sx of TS
+abdominal discomfort (hepatic congestion and hepatomegaly)
+fluttering sensation in neck caused by JVP
+JVD, ascites, peripheral edema
TS descriptions
soft, high-pitched, mid-diastolic
what is the best asucultation point for TS
4th intercostal space on sternal border
special notes for TS
increased during inspiration, squatiing or leg raise
TR causes
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
S/sx of TR
- majority are asxymptomatic
- Right sided heart failure: hepatomegaly, hepatic congestion, ascities, heptic venous hum, JVd,edema
description of TR
high-pitched, holosystolic murmur
best auscultation position for TR
4th LLSB,
where does TR radiate to?
right sternum, xiphoid
what can be done to hear TR better?
increased with inspiration, leg raises, or squatting
pulmonic stenosis causes
1) congenital (10% of children w/ congenital heart dz): TOF, noonan syndrome
2) bicuspid valves
3) calcification
s/sx of PS
- exertional dyspnea
- right heart failure
description of Ps
-midsystolic, high-pitched, crescendo-decrescendo
- pulmonary ejection click
- extends through the A2
- split S2
best auscultation point for PS
2-3rd LICS
special notes for PS
-increased during inspirations
Pulmonic regurg causes
1) primary: iatrogenic, infectious, rheumatic, congenital
2) pulmonary artery hypertension and or dilation
3) physiologic
PR s/s
asx until right ventricular dysfxn occures
- exertional dyspnea, fatigue
- tacyarrythmias
description of PR
soft, high-pitched, early diastolic decrescendo
-graham-steele murmur (pulmonary HTN): high-pitched, blowing with accentuated P2
best ausculatation point for PR
left 2 ICS
what can be done to help one hear PR?
increased with inspirations
what causes an S3
large amonut of blood hitting an very compliant LV (systolic heart failure)
best heart at apex
+ventricular gallop
S3 decription
Ken—-tuck-y
occures after S2
S4 cuases
Blood striking a non-compliant left ventricle
Diastolic heart failure, LVH
S4 description
Ten-nes—-see
apex , late diastolic murmu
what will you hear at the tricuspic area? (4-5 LICS)
Pansystolic: Tricuspid R, VSD
mid-to late diastolic: TS, ASD
what will you hear at aortic area? (2 RICS)
ejection type murmur: AS, flow murmur
what will you heart at pulmonic area (2 LICS)
ejection type: PS
what will you heart ate left sternal border/ erbs point
AR, PR (late diastolic)
what will you hear at mitral area? (aka apex)
pansystolic: MR
mid-to-late diastolic: MS
what are the diastolic murmuers?
AR, PR, MS
what are the systolic murmurs
mr. taps
what are the pansystolic murmurs?
MR, TR
