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Flashcards in heart murmurs Deck (33):
1

what are the diastolic heart murmurs?

mitral or tricuspid stenosis - narrowed valves cause turbulant flow from atrium to ventricals during ventricular filling - makes murmur

aortic or pulmonic regurgitation

2

what are the normal positions of the APTM valves during diastole?

T/M should be open
A/P should be closed

therefore if T/M stenosis (think about as difficulty with opening due to stiff/narrow valve) turbulant flow results in murmur during ventricular filling

similarly if there is regurgitation of the A/P valves (when they are supposed to be shut) turbulant flow is created by blood leaking back into the ventricals during filling (blood comes from both directions)

3

what are the normal positions of the APTM valves during systole?

T/M should be closed - so regurgitant makes murmur
A/P should be open - so stenosis makes murmur

4

what murmur is accentuated by hand-grip?

mitral regurgitation - handgrip increases SVR and afterload

5

what does the valsalva manuver accomplish, how does this contrast with inspiration?

valsalva increases intrathoracic pressure - opposite of inspiration - reduces pre-load and afterload

6

most murmors get quieter due to valsalva because less venous return and also less afterload. One murmur is increased by valsalva - which is it?

hypertrophic cardiomyopathy

7

what causes an early diastolic murmur best heart on the left sternal boarder with a wide pulse pressure and bounding peripheral pulses?

aortic regurgitation

normal systolic pressure with low systemic diastolic due to regurg makes for bounding pulses or "water hammer pulse"

can also cause head-bobbing

8

what causes aortic regurgitation?

aortic root dilation - e.g. from syphalus (can also cause aortic stenosis with "tree" barking or aorta) or marfans syndrojme

bicupid aortic valve
Rhumatic fever

9

what heart murmur is heart best at the apex of the heart and is louder when laying in the left lateral decubitus position

mitral stenosis - diastolic murmor with short delay from S2 and opening click

mitral regurgitation - systolic murmor immediately after S1

left sided S3,S4

10

how is mitral stenosis affected by breathing?

enhanced by expiration because more blood is returning to the left atrium

11

how does a PDA present as a murmur?

machine-like holosystolic murmor

close with indomethacin

12

when would aortic stenosis be heart in regard to the cardiac cycle?

systolic murmor that occurs immediately following isovolumetric contraction (slightly delayed ejection click) - shortly after S1

13

what causes a cresciendo decresecndo systolic heart murmor best heard at the right sternal boarder with radiation to the corrotids and weak, delayed peripheral pulses?

aortic stenosis

narrowed stenotic valve blocks blood from getting into aorta, reducing force of each contraction felt in peripheral pulses

14

pt has a systolic heart murmur with radiation to the corrotids and weak, delayed peripheral pulses. What other finding might be present?

syncope
angina
SOB/dyspnea

15

what are the causes of aortic stenosis?

MC = bicuspid aortic valve (becomes problem >40)
senile calcification (>60)
chronic rhumatic heart disease

16

what causes a holosystolic murmor that beings immediately following S1 and is best heart at the apex, with radiation to the left axilla?

mitral regugitation

17

which systolic heart murmur is enhanced by laying in the left lateral decubitus position, squatting or with hand-grip?

mitral regugitation

18

how does mitral valve prolapse present?

mid-systolic click

large valve leaflets take a long time to reach the furthest stretch point of the cordae tendinae as they close and billow back into the atrium during systole

19

does tricupid regurgitation present?

same as mitral regurge (holosystolic) but heard at the left lower sternal boarder rather than mid clavifular line/apex

20

does tricupid regurge get loader with inspiration or expiration?

inspiration because increased venous return gives right ventrical more preload to push back through tricuspid valve

21

how does a ventricular septal defect present?

holosystolic murmur that presents essentially identical to tricuspid regurgitation (holosystolic murmur best heard at left lower sternal boarder) and gets loader with inspiration

MUST USE CLINICAL SCENARIO TO DIFFERNTIATE
if newborn ==> VSD
if IV drug user ==> tricuspid regugitation

22

which heart murmur is assocaited with weak pulses?

aortic stenosis (pulses parvus et tardus) weak and delayed

23

what murmor is associated with a cresiendo decreasendo systolic murmur best heard at the 2nd right intercostal space?

aortic stenosis

24

what causes an early diastolic decresciendo murmur best heard along upper left of sternum?

pulmonic regurg

25

what causes a late diastolic decresiendo murmur best heard along lower left side of sternum?

tricuspid stenosis

26

pansystolic murmur heard best at the apex and often radiates to the left axilla?

mitral regurg

27

late systolic murmur usually preceded by a mid-systolic click

mitral valve prolapse

28

crescendo-decresendo systolic mumur best heard in the 2nd-3rd left intercostal space at the left sternal boarder?

pulmonic stenosis

29

pansystolic murmur best heard along left lower sternal boarder that radiates to the right lower stenal boarder

tricuspid regurg or VSD

30

rubling late diastolic murmur with opening snap heard loudest at the apex

mitral stenosis?

31

continuous machine like murmor (holosystolic)

PDA

32

high pitched diastolic murmur asscated with widened pulse pressure?

aortic regurgitation

33

crescendo-decresendo murmor heard best between the apex and left sternal bboarder radiating to the suprasternal notch. Murmur becomes louder when standing.

hypertrphchic cardiomyopathy

louder with decreased preload

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