Flashcards in heart murmurs Deck (33):
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
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)
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
what murmur is accentuated by hand-grip?
mitral regurgitation - handgrip increases SVR and afterload
what does the valsalva manuver accomplish, how does this contrast with inspiration?
valsalva increases intrathoracic pressure - opposite of inspiration - reduces pre-load and afterload
most murmors get quieter due to valsalva because less venous return and also less afterload. One murmur is increased by valsalva - which is it?
what causes an early diastolic murmur best heart on the left sternal boarder with a wide pulse pressure and bounding peripheral pulses?
normal systolic pressure with low systemic diastolic due to regurg makes for bounding pulses or "water hammer pulse"
can also cause head-bobbing
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
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
how is mitral stenosis affected by breathing?
enhanced by expiration because more blood is returning to the left atrium
how does a PDA present as a murmur?
machine-like holosystolic murmor
close with indomethacin
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
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?
narrowed stenotic valve blocks blood from getting into aorta, reducing force of each contraction felt in peripheral pulses
pt has a systolic heart murmur with radiation to the corrotids and weak, delayed peripheral pulses. What other finding might be present?
what are the causes of aortic stenosis?
MC = bicuspid aortic valve (becomes problem >40)
senile calcification (>60)
chronic rhumatic heart disease
what causes a holosystolic murmor that beings immediately following S1 and is best heart at the apex, with radiation to the left axilla?
which systolic heart murmur is enhanced by laying in the left lateral decubitus position, squatting or with hand-grip?
how does mitral valve prolapse present?
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
does tricupid regurgitation present?
same as mitral regurge (holosystolic) but heard at the left lower sternal boarder rather than mid clavifular line/apex
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
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
which heart murmur is assocaited with weak pulses?
aortic stenosis (pulses parvus et tardus) weak and delayed
what murmor is associated with a cresiendo decreasendo systolic murmur best heard at the 2nd right intercostal space?
what causes an early diastolic decresciendo murmur best heard along upper left of sternum?
what causes a late diastolic decresiendo murmur best heard along lower left side of sternum?
pansystolic murmur heard best at the apex and often radiates to the left axilla?
late systolic murmur usually preceded by a mid-systolic click
mitral valve prolapse
crescendo-decresendo systolic mumur best heard in the 2nd-3rd left intercostal space at the left sternal boarder?
pansystolic murmur best heard along left lower sternal boarder that radiates to the right lower stenal boarder
tricuspid regurg or VSD
rubling late diastolic murmur with opening snap heard loudest at the apex
continuous machine like murmor (holosystolic)
high pitched diastolic murmur asscated with widened pulse pressure?