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Flashcards in Abnormal Heart Sounds Deck (41)
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1

Cardiac auscultation listening posts

Aortic valve = right 2nd ICS at SB

Pulmonic valve = left 2nd ICS at SB

Tricuspid valve = left 4th ICS at SB

Mitral valve = left 5th ICS at MCL

2

Grading of heart murmurs

Grade 1 = very faint

Grade 2 = quiet, soft, easily heard with stethoscope

Grade 3 = moderately loud

Grade 4 = loud with palpable thrill

Grade 5 = very loud with thrill; can hear with stethoscope

Grade 6 = heard without stethoscope

3

Systolic murmurs occur between ___ and ____

Diastolic murmurs occur between ___ and ____

S1; S2

S2; S1

4

What does S1 represent?

Closure of tricuspid valve and mitral valve

5

What does S2 represent?

Closure of aortic valve and pulmonic valve — may split with inspiration

6

Describe S3 heard in some pts

Dull, low pitch; best heard with bell (Kent-Tuck-y)

Physiologic in children, young adults

Pathologic in older adults = heart failure

Ventricular gallop

7

Describe S4 heard in some pts

Dull, low pitch; best heard with bell (Ten-Nes-See)

Forceful atrial contraction against stiffened low compliant ventricle

Atrial gallop

8

What are the systolic murmurs?

Mitral regurg (MVP)
Tricuspid regurg
Aortic stenosis
Pulmonic stenosis
VSD
Aortopulmonary shunts

9

What are the diastolic murmurs?

Aortic regurg
Pulmonic regurg
Mitral stenosis
Tricuspid stenosis
Atrial myxoma

10

What are the continuous murmurs?

PDA — machine-like

AV fistula

ASD with high LA pressure

Coarctation

11

What are the most common valvular heart diseases encountered today?

Degenerative (senile calcification)

Myxomatous degeneration (MVP)

Congenital (bicuspid aortic valve)



[decline in incidence of rheumatic valvular disease]

12

Chronic vs. acute etiologies of mitral regurg

Chronic:
MVP — Most common etiology
Mitral annular calcification


Acute:
Rupture of chordae tendinae
Rupture of papillary muscle
Ischemic Papillary muscle dysfunction (CAD/MI — next MCC of MR)
Infective endocarditis
Valve perforation

13

Symptoms of MR

Asymptomatic years —> fatigue, DOE, palpitations

Acute; volume overload/orthopnea, PND, RHF/LHF

14

PE findings with MR

Systolic murmur — blowing, prominent at apex; radiates into left axilla

Loudness of murmur correlates with severity

Decreased S1 or normal; may have systolic click

15

Sx of mitral stenosis

Arise in 4th decade

DOE, cough, orthopnea, PND, pulmonary edema, hemoptysis, arterial emboli, A.fib

Ortner syndrome: hoarseness d/t compression of left recurrent laryngeal n

16

mitral stenosis findings on PE

Malar flush — ruddy cheeks, blue facies

Increase S1; opening snap (OS) after S2

Rumbling, diastolic murmur — low pitched; best heard at apex. Use bell

17

Etiologies of aortic stenosis

Degenerative (calcific, senile, fibrosis, or sclerosis)

Congenital bicuspid aortic valve (BAV) - 1% of population

Rheumatic or postinflammatory scarring

[normal AoV area is 4.0 cm]

18

Symptoms of aortic stenosis

Arise in 6th decade

Exertional dyspnea, angina, syncope, heart failure

Without tx, prognosis is poor — most die w/i 3 years of developing syncope and w/i 2 years of onset of HF

19

Pathophysiology of aortic stenosis

Obstruction leads to pressure overload; LVH, increase LVED pressure

Gradient across valve

[severe AS if AoV <1 cm]

20

Aortic stenosis on PE

Narrow pulse pressure; decreased SV and systolic pressure

Delayed pulses - Parvis (weak-small)/Tardus (late)

Systolic murmur, harsh, 2nd ICS RSB; radiates into suprasternal notch/carotids

21

What is the Gallavardin phenomenon?

AS murmur radiates to apex (like MR)

22

Causes of acute vs. chronic aortic regurg

Acute: IE, aortic dissection, BAV


Chronic: Syphilis, ankylosing spondylitis

23

PE findings with aortic regurg

Diastolic decrescendo murmur, 3rd ICS LSB

Systolic murmur usually present, soft

Wide pulse pressure; bisferious pulse

De Musset sign, Corrigan’s pulse, Quincke’s pulse, Traube’s sign, Durozrey’s sign, Hill’s sign

Austin Flint murmur — can mimic mitral stenosis

24

Conditions associated with tricuspid regurg

Pulmonary HTN, inferior MI/RV infarct

25

What murmur is associated with prominent V wave in JVP?

Tricuspid regurg

26

PE findings with tricuspid regurg

Blowing systolic murmur LSB; increase with inspiration (Carvallo’s sign)

27

Murmur associated with mitral stenosis, tricuspid regurg, and RHD

Tricuspid stenosis

28

Tricuspid stenosis is associated with prominent ____ wave in JVP, ascites, and potentially pulsatile hepatomegalia

A

29

PE findings with tricuspid stenosis

Diastolic murmur LSB; increase with inspiration (Carvallo’s sign) and decrease with expiration and valsalva

30

Most cases of pulmonic regurg are due to ________

Pulmonary HTN