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Cardiology > Valves and Murmurs > Flashcards

Valves and Murmurs Flashcards

1
Q

beginning of systole and ventricular contraction

A

S1

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2
Q

where is S1 heard best?

A

apex

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3
Q

beginning of diastole and ventricular relaxation

A

S2

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4
Q

where is S2 heard best?

A

LU sternal border

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5
Q

when does S2 have a physiological split and what does it indicate?

A

inhalation
increased VR = delays closure of P valve

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6
Q

how does exhalation affect venous return, and therefore the valves?

A

decreased VR = A + P valves close together

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7
Q

what causes the paradoxical split in S2?

A

prolongation of left ventricular systole / delayed closure of aortic valve

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8
Q

what happens during inhalation of a paradoxical split in S2?

A

increase VR = no split heard

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9
Q

what happens during exhalation of a paradoxical split in S2?

A

decreased VR = split heard

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10
Q

what causes wide, fixed splitting with no respiratory variation?

A

atrial septal defect

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11
Q

what causes a wide split that varies with inspiration? (2)

A

RBBB
Pulmonary stenosis

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12
Q

what causes paradoxical splitting?

A

hypertrophic cardiomyopathy

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13
Q

heart sound known as the ventricular gallop

A

S3

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14
Q

heart sound known as the atrial gallop

A

S4

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15
Q

if a patient has afib, which heart sound will be missing?

A

S4

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16
Q

where are S3 and S4 both heard best if originating from LV?

A

over apex with patient in left lateral position

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17
Q

where are S3 and S4 both heard best if originating from RV?

A

over LL sternal border

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18
Q

what is the sound of rapid passive filling from the left atrium to the left ventricle?

A

S3

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19
Q

what does the S3 cadence sound like?

A

“ken-tuck-y”

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20
Q

in which 3 cases would an S3 be physiological?

A

athletic heart
hyperkinetic state
3rd trimester pregnancy

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21
Q

what is the most common pathological cause of an S3?

A

congestive heart failure

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22
Q

what does the S4 cadence sound like?

A

“Ten-nes-see”

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23
Q

an S4 is a the hallmark sound of what?

A

active myocardial infarction

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24
Q

most common early systolic sound; results from abrupt halting of aortic and pulmonic valves

A

aortic ejection click

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25
Q

where is the ejection click best heard?

A

apex

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26
Q

ejection click is associated with which valve?

A

aortic

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27
Q

high-frequency early diastolic sound indicating mitral stenosis

A

opening snap

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28
Q

what happens to the opening snap sound with inspiration?

A

diminishes

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29
Q

where is the opening snap best heard?

A

between apex and LL sternal border

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30
Q

the opening snap is associated with which valve?

A

mitral

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31
Q

high-frequency noise that is louder during inspiration

A

pericardial friction rub

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32
Q

what would cause a pericardial friction rub to disappear?

A

development of significant effusion

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33
Q

many patients with a pericardial friction rub also present with what?

A

tachycardia

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34
Q

where is a pericardial friction rub heard the lousest?

A

LL sternal border

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35
Q

a pericardial friction rub can sometimes be heard better during forced _____ with the patient leaning _____

A

expiration
forward

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36
Q

grade this murmur: absent thrill, very quiet murmur

A

1/6

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37
Q

grade this murmur: absent thrill, quiet murmur

A

2/6

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38
Q

grade this murmur: absent thrill, easily audible murmur

A

3/6

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39
Q

grade this murmur: present thrill, loud murmur

A

4/6

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40
Q

grade this murmur: present thrill, murmur audible with stethoscope half off chest

A

5/6

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41
Q

grade this murmur: present thrill, murmur audible without stethoscope

A

6/6

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42
Q

what 3 things cause an innocent murmur?

A

pregnancy
IV hydration
stress on body

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43
Q

where can an innocent murmur be heard best?

A

3rd ICS LSB (erb’s point)

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44
Q

what maneuver makes an innocent murmur louder?

A

when supine (increase venous return)

45
Q

what maneuver makes an innocent murmur disappear/softer?

A

sitting/standing (decrease venous return)

46
Q

what are the 2 most common murmurs?

A

aortic valve
mitral valve

47
Q

an obstruction of blood flow from the left ventricle to the aorta

A

aortic stenosis

48
Q

what is the major cause of aortic stenosis in adults?

A

congenital bicuspid aortic valve

49
Q

a patient presents with dyspnea on exertion, angina, syncope, and CHF symptoms. what could they be experiencing?

A

aortic stenosis

50
Q

what location would aortic stenosis be heard best?

A

right upper sternal border

51
Q

what 3 spaces would aortic stenosis radiate?

A

sternal notch
right carotid
apex

52
Q

what maneuvers would increase an aortic stenosis murmur? (3)

A

squats
sitting up
leaning forward

53
Q

what maneuvers would decrease an aortic stenosis murmur? (2)

A

standing
valsalva

54
Q

what is the treatment for symptomatic severe aortic valve stenosis?

A

valve replacement

55
Q

what is the treatment for aortic valve stenosis in high-risk patients or in non-surgery candidates?

A

aortic balloon valvotomy

56
Q

a condition in which the mitral valve leaflets close above the annular plane during systole

A

mitral valve prolapse

57
Q

what can mitral valve prolapse lead to?

A

mitral regurgitation

58
Q

what is the best marker of risk for serious complications of mitral valve prolapse?

A

severe mitral regurgitation

59
Q

what are the 2 most common causes of mitral valve prolapse?

A

idiopathic
marfan’s syndrome

60
Q

what location is mitral valve prolapse heard best?

A

lower left sternal border

61
Q

what space would mitral valve prolapse radiate?

A

axilla

62
Q

what maneuver would move the mitral valve prolapse click and murmur earlier in systole and louder?

A

standing, valsalva (decreased venous return)

63
Q

what maneuver would move the mitral valve prolapse click and murmur later in systole or have a softer sound?

A

(increased venous return)
squats, leg raises
pregnancy
supine

64
Q

what diagnostic should be used to diagnose mitral valve prolapse?

A

echocardiogram

65
Q

what medication can be used to treat adrenergic symptoms of mitral valve prolapse?

A

beta blockers

66
Q

what is the first-line management for MVP?

A

MV repair

67
Q

results in abnormal leaking of blood across the mitral valve from the left ventricle to the left atrium

A

mitral regurgitation

68
Q

what is the 2nd most common valvular disease behind aortic stenosis?

A

mitral regurgitation

69
Q

what is the most common cause of mitral regurgitation in developed countries?

A

mitral valve prolapse

70
Q

what is the most common cause of mitral regurgitation in developing countries?

A

rheumatic heart disease

71
Q

what is a secondary cause of mitral regurg?

A

enlarged ventricle

72
Q

a patient presents with exertional dyspnea, fatigue, and new onset atrial fibrillation. what are they likely experiencing?

A

severe mitral regurg

73
Q

what diagnostic is the gold standard for establishing and diagnosing the severity of MR?

A

echocardiogram

74
Q

what maneuver would increase a mitral regurg murmur?

A

hand grips

75
Q

what maneuver would decrease a mitral regurg murmur?

A

valsalva

76
Q

what 2 medications can be used for symptomatic patients with MR to decrease afterload?

A

hydralazine
nitroprusside

77
Q

what is the treatment for severe chronic MR?

A

MV surgical repair

78
Q

where would mitral regurg be heard best?

A

LLSB

79
Q

where would MR radiate? (3)

A

axilla
back
RU sternal border

80
Q

where would hypertrophic cardiomyopathy be heard best?

A

LLSB

81
Q

where would hypertrophic cardiomyopathy radiate?

A

sternal border

82
Q

what are 2 associated findings in hypertrophic cardiomyopathy?

A

paradoxically split S2
S4

83
Q

what 2 maneuvers would increase hypertrophic cardiomyopathy murmur?

A

valsalva
standing

84
Q

what 2 maneuvers would decrease hypertrophic cardiomyopathy murmur?

A

squats
leg raises

85
Q

what is tricuspid regurg a consequence of?

A

pulmonary hypertension

86
Q

where would tricuspid regurg be heard best?

A

3rd ICS LLSB

87
Q

a patient presents with head bobbing, pulsating earlobes and eyeballs, and pulsations in the neck. what are they likely experiencing?

A

tricuspid regurg

88
Q

what is the medical treatment for TR if right-sided HF is present? (2)

A

loop diuretics and aldosterone

89
Q

when is surgery indicated for TR?

A

only if mitral or aortic valve are involved

90
Q

why are diastolic murmurs easily missed?

A

they are often soft

91
Q

what is a cause of aortic regurgitation?

A

bicuspid aortic valve (marfan’s syndrome)

92
Q

a patient presents with exertional dyspnea, angina, and heart failure. what are they likely experiencing?

A

aortic regurg

93
Q

what medications can be used for aortic regurg? (2)

A

ACE inhibitors
CCB - vasodilate

94
Q

what medication can be used for the marfan’s syndrome in aortic regurg?

A

beta blocker

95
Q

when is surgical treatment for aortic regurg indicated?

A

is LV dysfunction exists

96
Q

what is the most important cause of mitral stenosis?

A

rheumatic fever

97
Q

a patient presents with dyspnea, increasing fatigue, orthopnea and/or paroxysmal nocturnal dyspnea. what are they likely experiencing?

A

mitral stenosis

98
Q

what treatment can be used in patients with MS + afib OR MS with prior embolic events?

A

anticoagulants

99
Q

what treatment can be used in patients with pulmonary vascular congestion to relieve orthopnea or paroxysmal nocturnal dyspnea due to MS?

A

diuretics + salt restriction

100
Q

what is the procedure of choice for symptomatic patients with mitral stenosis?

A

percutaneous mitral balloon valvotomy

101
Q

a patient presents with abdominal discomfort due to hepatomegaly and a sense of fluttering discomfort in the neck. what are they likely experiencing?

A

tricuspid stenosis

102
Q

what are the 2 treatment options for tricuspid stenosis?

A

valve surgery
percutaneous balloon valvotomy

103
Q

what is the most common cause of pulmonic regurg?

A

pulmonary hypertension

104
Q

a patient presents with RV dysfunction-induced heart failure. what are they likely experiencing?

A

pulmonic regurg

105
Q

what is the general treatment goal for pulmonic regurg?

A

treat pulmonary hypertension

106
Q

what is the treatment for patients with pulmonic regurg that present symptomatic with RV dysfunction-induced heart failure?

A

valve replacement

107
Q

mid-systolic pulmonary flow or ejection murmur, resulting from increased blood flow across the pulmonic valve (left to right shunt)

A

atrial septal defect

108
Q

loud machinery-like murmur heard over the left scapula and in the left infraclavicular area in patients with left to right shunting

A

patent ductus arteriosus

Cardiology (19 decks)

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