Valves and Murmurs Flashcards
1
Q
beginning of systole and ventricular contraction
A
S1
2
Q
where is S1 heard best?
A
apex
3
Q
beginning of diastole and ventricular relaxation
A
S2
4
Q
where is S2 heard best?
A
LU sternal border
5
Q
when does S2 have a physiological split and what does it indicate?
A
inhalation
increased VR = delays closure of P valve
6
Q
how does exhalation affect venous return, and therefore the valves?
A
decreased VR = A + P valves close together
7
Q
what causes the paradoxical split in S2?
A
prolongation of left ventricular systole / delayed closure of aortic valve
8
Q
what happens during inhalation of a paradoxical split in S2?
A
increase VR = no split heard
9
Q
what happens during exhalation of a paradoxical split in S2?
A
decreased VR = split heard
10
Q
what causes wide, fixed splitting with no respiratory variation?
A
atrial septal defect
11
Q
what causes a wide split that varies with inspiration? (2)
A
RBBB
Pulmonary stenosis
12
Q
what causes paradoxical splitting?
A
hypertrophic cardiomyopathy
13
Q
heart sound known as the ventricular gallop
A
S3
14
Q
heart sound known as the atrial gallop
A
S4
15
Q
if a patient has afib, which heart sound will be missing?
A
S4
16
Q
where are S3 and S4 both heard best if originating from LV?
A
over apex with patient in left lateral position
17
Q
where are S3 and S4 both heard best if originating from RV?
A
over LL sternal border
18
Q
what is the sound of rapid passive filling from the left atrium to the left ventricle?
A
S3
19
Q
what does the S3 cadence sound like?
A
“ken-tuck-y”
20
Q
in which 3 cases would an S3 be physiological?
A
athletic heart
hyperkinetic state
3rd trimester pregnancy
21
Q
what is the most common pathological cause of an S3?
A
congestive heart failure
22
Q
what does the S4 cadence sound like?
A
“Ten-nes-see”
23
Q
an S4 is a the hallmark sound of what?
A
active myocardial infarction
24
Q
most common early systolic sound; results from abrupt halting of aortic and pulmonic valves
A
aortic ejection click
25
where is the ejection click best heard?
apex
26
ejection click is associated with which valve?
aortic
27
high-frequency early diastolic sound indicating mitral stenosis
opening snap
28
what happens to the opening snap sound with inspiration?
diminishes
29
where is the opening snap best heard?
between apex and LL sternal border
30
the opening snap is associated with which valve?
mitral
31
high-frequency noise that is louder during inspiration
pericardial friction rub
32
what would cause a pericardial friction rub to disappear?
development of significant effusion
33
many patients with a pericardial friction rub also present with what?
tachycardia
34
where is a pericardial friction rub heard the lousest?
LL sternal border
35
a pericardial friction rub can sometimes be heard better during forced _____ with the patient leaning _____
expiration
forward
36
grade this murmur: absent thrill, very quiet murmur
1/6
37
grade this murmur: absent thrill, quiet murmur
2/6
38
grade this murmur: absent thrill, easily audible murmur
3/6
39
grade this murmur: present thrill, loud murmur
4/6
40
grade this murmur: present thrill, murmur audible with stethoscope half off chest
5/6
41
grade this murmur: present thrill, murmur audible without stethoscope
6/6
42
what 3 things cause an innocent murmur?
pregnancy
IV hydration
stress on body
43
where can an innocent murmur be heard best?
3rd ICS LSB (erb's point)
44
what maneuver makes an innocent murmur louder?
when supine (increase venous return)
45
what maneuver makes an innocent murmur disappear/softer?
sitting/standing (decrease venous return)
46
what are the 2 most common murmurs?
aortic valve
mitral valve
47
an obstruction of blood flow from the left ventricle to the aorta
aortic stenosis
48
what is the major cause of aortic stenosis in adults?
congenital bicuspid aortic valve
49
a patient presents with dyspnea on exertion, angina, syncope, and CHF symptoms. what could they be experiencing?
aortic stenosis
50
what location would aortic stenosis be heard best?
right upper sternal border
51
what 3 spaces would aortic stenosis radiate?
sternal notch
right carotid
apex
52
what maneuvers would increase an aortic stenosis murmur? (3)
squats
sitting up
leaning forward
53
what maneuvers would decrease an aortic stenosis murmur? (2)
standing
valsalva
54
what is the treatment for symptomatic severe aortic valve stenosis?
valve replacement
55
what is the treatment for aortic valve stenosis in high-risk patients or in non-surgery candidates?
aortic balloon valvotomy
56
a condition in which the mitral valve leaflets close above the annular plane during systole
mitral valve prolapse
57
what can mitral valve prolapse lead to?
mitral regurgitation
58
what is the best marker of risk for serious complications of mitral valve prolapse?
severe mitral regurgitation
59
what are the 2 most common causes of mitral valve prolapse?
idiopathic
marfan's syndrome
60
what location is mitral valve prolapse heard best?
lower left sternal border
61
what space would mitral valve prolapse radiate?
axilla
62
what maneuver would move the mitral valve prolapse click and murmur earlier in systole and louder?
standing, valsalva (decreased venous return)
63
what maneuver would move the mitral valve prolapse click and murmur later in systole or have a softer sound?
(increased venous return)
squats, leg raises
pregnancy
supine
64
what diagnostic should be used to diagnose mitral valve prolapse?
echocardiogram
65
what medication can be used to treat adrenergic symptoms of mitral valve prolapse?
beta blockers
66
what is the first-line management for MVP?
MV repair
67
results in abnormal leaking of blood across the mitral valve from the left ventricle to the left atrium
mitral regurgitation
68
what is the 2nd most common valvular disease behind aortic stenosis?
mitral regurgitation
69
what is the most common cause of mitral regurgitation in developed countries?
mitral valve prolapse
70
what is the most common cause of mitral regurgitation in developing countries?
rheumatic heart disease
71
what is a secondary cause of mitral regurg?
enlarged ventricle
72
a patient presents with exertional dyspnea, fatigue, and new onset atrial fibrillation. what are they likely experiencing?
severe mitral regurg
73
what diagnostic is the gold standard for establishing and diagnosing the severity of MR?
echocardiogram
74
what maneuver would increase a mitral regurg murmur?
hand grips
75
what maneuver would decrease a mitral regurg murmur?
valsalva
76
what 2 medications can be used for symptomatic patients with MR to decrease afterload?
hydralazine
nitroprusside
77
what is the treatment for severe chronic MR?
MV surgical repair
78
where would mitral regurg be heard best?
LLSB
79
where would MR radiate? (3)
axilla
back
RU sternal border
80
where would hypertrophic cardiomyopathy be heard best?
LLSB
81
where would hypertrophic cardiomyopathy radiate?
sternal border
82
what are 2 associated findings in hypertrophic cardiomyopathy?
paradoxically split S2
S4
83
what 2 maneuvers would increase hypertrophic cardiomyopathy murmur?
valsalva
standing
84
what 2 maneuvers would decrease hypertrophic cardiomyopathy murmur?
squats
leg raises
85
what is tricuspid regurg a consequence of?
pulmonary hypertension
86
where would tricuspid regurg be heard best?
3rd ICS LLSB
87
a patient presents with head bobbing, pulsating earlobes and eyeballs, and pulsations in the neck. what are they likely experiencing?
tricuspid regurg
88
what is the medical treatment for TR if right-sided HF is present? (2)
loop diuretics and aldosterone
89
when is surgery indicated for TR?
only if mitral or aortic valve are involved
90
why are diastolic murmurs easily missed?
they are often soft
91
what is a cause of aortic regurgitation?
bicuspid aortic valve (marfan's syndrome)
92
a patient presents with exertional dyspnea, angina, and heart failure. what are they likely experiencing?
aortic regurg
93
what medications can be used for aortic regurg? (2)
ACE inhibitors
CCB - vasodilate
94
what medication can be used for the marfan's syndrome in aortic regurg?
beta blocker
95
when is surgical treatment for aortic regurg indicated?
is LV dysfunction exists
96
what is the most important cause of mitral stenosis?
rheumatic fever
97
a patient presents with dyspnea, increasing fatigue, orthopnea and/or paroxysmal nocturnal dyspnea. what are they likely experiencing?
mitral stenosis
98
what treatment can be used in patients with MS + afib OR MS with prior embolic events?
anticoagulants
99
what treatment can be used in patients with pulmonary vascular congestion to relieve orthopnea or paroxysmal nocturnal dyspnea due to MS?
diuretics + salt restriction
100
what is the procedure of choice for symptomatic patients with mitral stenosis?
percutaneous mitral balloon valvotomy
101
a patient presents with abdominal discomfort due to hepatomegaly and a sense of fluttering discomfort in the neck. what are they likely experiencing?
tricuspid stenosis
102
what are the 2 treatment options for tricuspid stenosis?
valve surgery
percutaneous balloon valvotomy
103
what is the most common cause of pulmonic regurg?
pulmonary hypertension
104
a patient presents with RV dysfunction-induced heart failure. what are they likely experiencing?
pulmonic regurg
105
what is the general treatment goal for pulmonic regurg?
treat pulmonary hypertension
106
what is the treatment for patients with pulmonic regurg that present symptomatic with RV dysfunction-induced heart failure?
valve replacement
107
mid-systolic pulmonary flow or ejection murmur, resulting from increased blood flow across the pulmonic valve (left to right shunt)
atrial septal defect
108
loud machinery-like murmur heard over the left scapula and in the left infraclavicular area in patients with left to right shunting
patent ductus arteriosus
