CVPR Week 3: Listening to heart murmurs Flashcards
(76 cards)
1
Q
What causes heart murmurs?
A
Turbulent flow
2
Q
Turbulent flow
A
Forward flow
Backward flow
Shunt from left side circulation to right side or vice versa
3
Q
What determines how loud a murmur is?
2 listed
A
- Degree of turbulence
- Shape and thickness of the chest wall
4
Q
What determines the length of time a murmur can be heard?
A
Length proportional to the duration of turbulence
5
Q
How do we describe murmurs?
5 listed
A
- Timing *systole vs diastole)
- Intensity
- Location
- Radiation
- Frequency (pitch)
- Related to velocity
- Stethoscope to help distinguish frequencies
6
Q
Stethoscope: Bell for?
A
Low frequencies
7
Q
Stethoscope: Diaphragm for?
A
high frequencies
8
Q
Grading of heart murmurs
A
9
Q
Grade 1 Heart Murmur
A
Very faint
not always heard in all positions
10
Q
Grade 2 Heart Murmur
A
quiet but not difficult to hear
11
Q
Grade 3 Heart Murmur
A
moderately loud
12
Q
Grade 4 Heart Murmur
A
Loud +/- thrills
13
Q
Grade 5 Heart Murmur
A
- Very loud +/- thrills
- may be heard with stethoscope partly off the chest
14
Q
Grade 6 Heart Murmur
A
- may be heard with stethoscope completely off the chest
- +/- thrills
15
Q
Cardiac Auscultation sites
A
16
Q
Shape of murmurs
A
- Systolic
- Diastolic
17
Q
Evaluating Cardiac Murmurs
9 listed
A
18
Q
Position of murmur
A
19
Q
Position of murmur: Supine
A
General auscultation and most heart sounds
20
Q
Position of murmur: Sitting up and leaning forward and holding exhalation
A
- Aortic stenosis
- aortic regurgitation
- Pericardial rubs
21
Q
Position of murmur: Left lateral decubitus
A
S3, S4, Mitral stenosis (using bell of stethoscope)
22
Q
Position of murmur: Valsalva manoeuver
A
increases intensity of mitral valve prolapse and hypertrophic cardiomyopathy
decreases intensity of aortic stenosis
23
Q
Position of murmur: Squating and standing
A
- increases intensity of aortic stenosis
- Decreases intensity of outflow obstruction in hypertrophic cardiomyopathy
24
Q
Describe
A
25
Heart sound questions: **S1**
## Footnote
**S1**
C: During isovolumetric contraction
26
Heart sound questions: **S2**
## Footnote
**S2**
during isovolumetric relaxation
27
S3 occurs when?
28
S4 occurs when?
29
Pressure-volume loop
30
In what phase of the pressure-volume loop is this heart?
Isovolumetric relaxation
31
In what phase of the pressure-volume loop is this heart?
Ejection
32
Echo imaging of the heart
33
The most familiar form of imaging of the heart
Echo imaging of the heart
34
Appears like a movie strip with continuous action through a slice of the heart
Echo imaging of the heart
35
2D imaging produces a "thin slice" through the part of the heart being interrogated
Echo imaging of the heart
36
Identify
37
Current role of Echocardiography
38
How is Echo used?
39
Identify
40
On the pressure-volume loop, when would one hear the murmur of aortic stenosis?
41
What is this?
Aortic stenosis
42
Where is aortic stenosis best heard?
right second intercostal space on the sternal border
43
How is the sound of Aortic stenosis described?
as a crescendo-decrescendo systolic ejection murmur
44
What is this?
aortic regurgitation
45
Where is aortic regurgitation best heard
along the right sternal border in the 2nd intercostal space
46
How is the sound of aortic regurgitation described?
It is described as an early diastolic decrescendo murmur
47
aortic regurgitation can be present with?
a bounding pulse or wide pressure pulse
48
common causes of aortic regurgitation?
* Bicuspid aortic valve
* endocarditis
* Rheumatic fever
* Aortic root dilation
49
What is this?
S3 heart sound
This is the the sound of the S3 heart sound. It is heard normally in young adults and children, in pregnancy and athletes. It is abnormal older adults and may signify heart failure or cardiomyopathy.
50
Best patient position to hear the S3 heart sound?
* Left lateral decubitus position
* on the cardiac apex in the 5th intercostal space
51
S3 heart sound should be listed to with which part of the stethoscope?
The bell and should be faint or absent with the diaphragm
52
S3 heart sound is produced by?
blood coming into contact with a compliant ventricle
53
S3 heart sound in elderly may signify?
* Heart failure
* Cardiomyopathy
* Severe mitral or tricuspid regurgiation
54
How is the S3 heart sound described?
The S3 has a low pitch vs the split S2 which is high pitched
55
What is this?
Holosystolic murmur
56
Holosystolic murmur is produced by?
Typically caused by mitral & Tricuspid regurgitation
or
Ventricular septal defects
57
Holosystolic murmur is best heard where?
58
Holosystolic murmur radiation?
59
Holosystolic murmur sound is described as
a high pitched blowing murmur
60
Holosystolic murmur common causes
* Mitral valve disease
* Rheumatic fever
* mitral valve prolapse
* infective endocarditis
* congenital abnormality through a hole in the interventricular septum
61
What is this?
Normal heart sound
62
What is this?
S4 heart sound
63
Atrial gallop AKA
S4 heart sound
64
The best place to hear the S4 heart sound?
* lateral left decubitus position
* with the bell of the stethoscope
65
The S4 heart sound is a sign of?
Diastolic heart failure
66
The S4 heart sound is produced by?
when the atria contract forcing blood into a non-compliant ventricle
often heard in severe left ventricular hypertrophy
67
often heard in severe left ventricular hypertrophy
S4 heart sound
68
Often heard during active cardiac ischemia
S4 heart sound
69
What is this?
Mitral stenosis
70
Mitral stenosis is best heard?
71
Mitral stenosis is produced by?
rapid closing of thickened mitral valves
caused by the valve cusps snaping into the left ventricle
72
Mitral stenosis sound is described as?
low-pitched decrescendo-crescendo rumbling diastolic murmur
73
Mitral stenosis becomes louder by?
valsalva maneuver, squating or activities that increase afterload
74
On the pressure-volume loop when would you hear the murmur of mitral stenosis?
75
On the pressure-volume loop when would you hear the murmur of mitral regurgitation?
76
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