Phys exam skills: Murmurs Flashcards
- Slow rise of the carotid pulse
- mid to late peak intensity murmur
- decreased intensity of the 2nd heart sound
dx aortic stenosis
- absence of murmur radiation to the R carotid artery
r/o aortic stenosis
Heart murmurs are produced when _____.
turbulent blood flow causes prolonged auditory vibrations of cardiac structures
- max intensity at 2nd R intercostal space
2. radiates to the R carotid artery and R clavicle
typical for aortic stenosis
typical findings for aortic stenosis?
- max intensity at 2nd R intercostal space
2. radiates to the R carotid artery and R clavicle
- max intensity at 5/6th L intercostal space, midclavicular
2. radiates to the L anterior axilla line and L axilla
typical for mitral regurg
typical findings for mitral regurg?
- max intensity at 5/6th L intercostal space, midclavicular
2. radiates to the L anterior axilla line and L axilla
- max intensity at the lower L sternal border
2. radiates to the lower R sternal border, epigastrum, 5th intercostal space- mid L thorax
typical findings for tricuspid regurg
typical findings for tricuspid regurg?
- max intensity at the lower L sternal border
2. radiates to the lower R sternal border, epigastrum, 5th intercostal space- mid L thorax
- max intensity at the 5th L intercostal space, midclavicular
- radiates to the lower L sternal border
typical for hypertrophic cardiomyopathy
typical findings for hypertrophic cardiomyopathy?
- max intensity at the 5th L intercostal space, midclavicular
- radiates to the lower L sternal border
What is apical-carotid delay? What does it mean?
assess the R carotid pulse and R brachial arterial pulse simultaneously with both hands. Delay btw the 2 = abnormal.
What signifies a grade 4 murmur?
a thrill (palpable precordial vibration)
How is the 4th heart sound best heard?
using the bell of the stethoscope in the L lateral decubitus position
____ are associated with MVP.
Systolic clicks
Systolic clicks are associated with ____.
MVP
What maneuvers increase the intensity of R sided murmurs? How do they do this?
- quiet inspiration
- sustained ab pressure
…. by increasing venous return
How are L sided heart murmurs intensified? How do they do this?
place an inflated BP cuff on each arm- murmur should intensify after 20 sec
…. by increasing systemic arterial resistance
What maneuvers increase venous return AND systemic arterial resistance?
standing to squatting, passive leg elevation
How does the Valsalva maneuver decrease the intensity of aortic stenosis murmurs?
it decreases venous return and increases systemic arterial resistance
