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Flashcards in Heart Sounds Deck (33)
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1
Q

Crescendo-decrescendo systolic ejection murmur (maybe with ejection click)

A

aortic stenosis

2
Q

Holosystolic, high-pitched “blowing murmur”

A

Mitral/Tricuspid regurg

3
Q

Midsystolic click followed by late systolic crescendo murmur

A

mitral valve prolapse (mid-systolic click is from sudden tensing of chordae tendineae)

Note: that an early systolic click is a sign of bicuspid aortic valve prior to stenosis

4
Q

Holosystolic, harsh-sounding murmur. Loudest at tricuspid area.

A

VSD

5
Q

High-pitched “blowing” early diastolic decrescendo murmur

A

aortic regurgitation

6
Q

Diastolic opening snap followed by rumbling late diastolic murmur

A

mitral stenosis

7
Q

Continuous machine-like murmur

A

PDA

8
Q

Pulsus parvus et tardus is associated with:

A

aortic regurgitation (pulses are weak with delayed peak)

9
Q

What symptoms is aortic stenosis assoc with:

A

SAD - syncope, angina, dyspnea on exertion

10
Q

Radiates toward axilla

A

mitral regurg

11
Q

Radiates towards right sternal border

A

tricuspid regurg

12
Q

Most frequent valvular lesion

A

mitral prolapse

13
Q

Myxomatous degeneration (Marfan or Ehlers-Danlos) causes:

A

mitral prolapse

14
Q

Signs of aortic regurgitation

A
  • hyperdynamic pulse
  • head bobbing when severe
  • Wide pulse pressure
15
Q

Rheumatic fever usually causes:

A

Mitral stenosis (which can lead to LA dilation and compression of L. recurrent laryngeal nerve)

16
Q

What indicates a more severe mitral stenosis?

A
  • less time between S2 and opening snap = more severe

Note: LA pressure&raquo_space; LV pressure during diastole

17
Q

Radiates to carotids

A

aortic stenosis

18
Q

Causes of aortic regurg:

A
  • aortic root dilation
  • bicuspid aortic valve (which also does stenosis)
  • endocarditis
  • rheumatic fever
19
Q

Fixed splitting

A

ASD (from left-right shunt increases flow through pulmonic valve that delays closure)

20
Q

What is an S3 sound? What does it indicate?

A

S3- early diastole from rapid ventricular filling

Assoc: increase filling pressure (mitral regurge, HF, dilated ventricles, normal in kids)

21
Q

What is an S4 sound?

A

S4- late diastole (“atrial kick” from hitting stiff ventricle)

Assoc: hypertrophy (from HTN)

22
Q

Order of valves closing in normal splitting and why this occurs

A
  1. aortic close
  2. pulmonic close (S2)

Increased venous returns during inspiration, increases RV filling and delays the P closing

23
Q

Wide splitting causes

A
  • delay in RV emptying/pulmonic valve closure

pulmonic stenosis, RBBB

24
Q

Paradoxical splitting causes

A
  • delay in aortic valve closure (P sound before A)

aortic stenosis, LBBB

25
Q

Inspiration and flow in heart

A

increases in venous return to RA (thus increases right heart sounds)

26
Q

Hand grip and flow in heart

A

increases in afterload

27
Q

Valsalva and flow in heart

A

decreases preload (thus decreasing intensity of most murmurs except for HCM)

28
Q

Standing up and flow in heart

A

decreases preload (like valsalva)

29
Q

Rapid squatting

A

increases preload (venous return) and afterload

30
Q

Systolic heart sounds

A
  • A/P stenosis, M/T regurg, VSD, MVP
31
Q

Diastolic heart sounds

A
  • A/P regurg, M/T stenosis
32
Q

Presystolic murmur (think opening snap and diastolic rumble) that disappears with a. fib

A

M/T stenosis

33
Q

Systolic ejection murmur in HCM LVOT vs aortic stenosis

A

HCM LVOT murmur: increases when standing (less blood filling LV = more obstruction)

Aortic stenosis = standing decreases afterload and thus reduces murmur