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CPR II Exam #2 > Valvular Heart Disease and Murmurs > Flashcards

Valvular Heart Disease and Murmurs Flashcards

1
Q

2 most common causes of valvular heart disease

A

Myxomatous degeneration

Congential (bicuspid aortic valve)

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2
Q

What kind of overload is associated with stenosis vs. regurg?

A

Stenosis - pressure overload, hypertrophy and HF

Regurg - volume overload, dilation

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3
Q

Which murmurs are systolic?

A

MATPAV

Mitral regurg
Aortic stenosis
Tricuspid regurg
Pulmonic stenosis
ASD
VSD
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4
Q

Which murmurs are diastolic?

A

PAMTA

Pulmonic insufficiency/regurg
Aortic insufficiency/regurg
Mitral stenosis
Tricuspid stenosis
Atrial myxoma
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5
Q

Grading scale for murmurs

A

1 - barely audible
2 - faint, soft
3 - louder, easy heard
4 - very loud w/ palpable thrill
5 - heard w/ steth barely touching the chest with thrill
6 - can be heard w/o steth w/ palpable thrill

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6
Q

Causes of acute MR regurg murmur (4)

A

Ischemic papillary m.
ruptured chordae tendinae
IE
Vol overload

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7
Q

Causes of chronic MR regurg murmur

A

MVP

Myxomatous degeneration

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8
Q

What does a murmur associated with a PE sound like? (4)

A

Systolic
Blowing at apex
Radiates to left axilla
Reduced S1

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9
Q

MVP has what effect on the morphology of the valve?

What are the SX?

What does it sound like?

It’s sound increases with…

What should you do?

A

Redundant tissue w/ myxomatous degeneration

Usually ASX

Mid-systolic click

Increases with decreased ventricular vol

Reassure or give BB is symptomatic

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10
Q

Tricuspid regurg is usually…

When should you be worried?

What does it sound like?

What is noted on the jugular venous pulse?

A

Common, ASX and functional.

If associated with pulm HTN, lung disease, RV infarct, MI, IE or pacemaker.

Blowing systolic murmur at 4th ICS at LSB. Increases on inspiration (Carvallo sign).

Prominent V wave

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11
Q

Aortic stenosis is most commonly caused by:

What happens to the heart as a consequence?

SX?

A

Degenerative calcification

Volume overload -> LVH

DOE, angina and syncope

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12
Q

How does an aortic stenosis murmur sound?

What heart sound is diminished?

The pulses will be parvus and tarvus. What does that mean?

What pattern is seen on ECG?

A

Crescendo-decrescendo, harsh at 2 ICS at RSB and radiated to sternal notch/carotids.

Diminished S2

Parvus - weak/small
Tarvus - slow rising, late

LVH, strain pattern (down sloping of ST segment - T wave)

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13
Q

Bicuspid aortic valve is associated with what outcomes?

Where is it heard best?

How many develop aortic stenosis?

What diseases?

A

Aortic root dilation (aneurysms), IE

LSB or apex

75% develop aortic stenosis

Marfans and Turner syndrome

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14
Q

What is the cause of pulmonary stenosis?

What does it sound like? Where is it heard best?

What might it be associated with?

A

Congenital

Crescendo-decrescendo. 2-3 ICS at LSB, radiating to axilla/clavicle.

ToF

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15
Q

VSD murmur sounds like:

Where is it heard best?

Increases with…

A

Holosystolic murmur with thrill.

Left lower SB

Inc with handgrip

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16
Q

ASD murmur is heard best at?

What heard sound is most affected?

A

Upper LSB

Fixed splitting of S2

17
Q

Causes of mitral stenosis (3)

A

RHD - grp A Strep.
Congenital
Annular calcification

18
Q

SX of mitral stenosis (5)

A 
DOE
Orthopnea
Palpitations
AFib
Hoarseness
19
Q

What does a mitral stenosis murmur sound like?

Where is it heard best?

What happens to the ECG?

A

Low pitched with an increased S1 and S2 followed by an opening snap.

LAE if in sinus rhyth

20
Q

Tricuspid stenosis is usually from:

Associated with? More common in?

It increases with…

What happens to the jugular venous graph?

What happens on ECG?

A

RHD

Associated with mitral stenosis; females

Inspiration (Carvallo sign)

Prominent A wave (atrial contraction)

RAE

21
Q

Aortic insufficiency/regurg is acutely caused by: (3)

Chronic aortic insufficiency/regurg? (4)

On pathology there is…

SX for acute vs. chronic:

A

IE, aortic dissection, chest trauma

Calcific degenration, BAV, dilated aortic root, RHD

Vol overload*; LVH

Acute - pulmonary edema from IE
Chronic - dyspnea, orthopnea, angina

22
Q

Aortic insufficiency/regurg murmur sounds like…

Where is it heard best?

It is associated with DeMusset, Quincke’s, Traube and Duroziez signs. What are they?

What is given as an Rx?

A

Diastolic decrescendo murmur

3rd ICS, LSB

DeMussett - head bob with beats
Quincke’s - capillary nail pulsations
Traube - “pistol shot” sounds over femoral a.
Duroziez - diastolic murmur over the femoral a.

ACE-I or ARB to decrease afterload

23
Q

Pulmonary insufficiency/regurg sounds like:

Where is it heard best?

Associated with…

A

Decrescendo murmur

2nd ICS at LSB

Pulm HTN; increased S2

24
Q

Crescendo-decrescendo murmur

2-3rd ICS at LSB

A

Pulmonary stenosis

25
Q

Decrescendo murmur

3rd ICS at LSB

A

Aortic regurg

26
Q

Decrescendo

2nd ICS

A

Pulmonary regurg

27
Q

Blowing murmur at 4th ICS at LBS

Prominent V wave

A

Tricuspid regurg

28
Q

Crescendo-decrescendo murmur harsh at 2nd ICS at RBS
Decreased S2
Strain pattern on ECG

A

Aortic stenosis

29
Q

Prominent A wave

A

Tricuspid stenosis

30
Q

Which murmur radiates to the axilla from the apex?

A

Mitral regurgitation

CPR II Exam #2 (20 decks)

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