Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BLOCK C > Heart sounds and murmurs > Flashcards

Heart sounds and murmurs Flashcards

1
Q

Portion of stethoscope for high pitched vs low pitched sounds

A

Diaphragm: high pitched
Bell: low pitched

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is S1 best heard + characteristics

A

Near apex of the heart
High pitched
Single sound (composed of M1 and T1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

S2 characteristics

A

Closure of aortic and pulmonic valves.
A2 and P2 components.
High pitched.

A2 and P2 can dissociate when breathing (“physiologic splitting”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ejection click characteristics

A

Shortly after S1
High pitched, sharp sound

Can be heard in aortic or pulmonic valve stenosis or in dilatation of pulmonary artery or aorta.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mid- or late-systolic clicks characteristics.

A

AKA non-ejection clicks
Heard in mitral valve prolapse or tricuspid valve prolapse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Opening snap characteristics

A

Diastolic click
Mitral or tricuspid valve stenosis
Sharp and high-pitched
“Hockey stick”
Best heard between the apex and the left sternal border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

S3 characteristics

A

Low-pitched, dull sound
Best heard over cardiac apex
Due to tensing of chordae tendinae during rapid filling of ventricle, or from blood hitting ventricular wall.

Can be normal or abnormal (dilated ventricle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Another name for pathologic S3

A

Ventricular gallop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

S4 characteristics

A

Low-pitched, dull sound
Best heart over cardiac apex with left lateral decubitus

Indicative of decreased ventricular compliance due to ventricular hypertrophy or MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Another name for S4

A

Atrial gallop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a summation gallop

A

When patient with quadruple rhythm has tachycardia, S3 and S4 coalesce and produce a “summation gallop”.

Long mid-systolic low pitched sound but louder than S1 and S2.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a pericardial knock

A

High pitched sound in patients with constrictive pericarditis.

Early diastolic, can be confused with OS or S3 (between OS and S3, louder than OS).

Occurs when expanding ventricle meets rigid pericardium in diastole.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Does laminar flow emit sound?

A

No.
Murmurs result from turbulent flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5 mechanisms resulting in murmurs

A
  1. Stenosis
  2. Increased flow in normal structure
  3. Ejection into dilated chamber
  4. Regurgitation
  5. Shunting of blood from high to low pressure chamber (ventricular septal defect)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

7 hallmarks to describe murmurs

A

Tiny insects prefer shady little rocks.

  1. timing (diastole or systole or continuous)
  2. intensity
  3. pitch
  4. shape
  5. location
  6. radiation
  7. response to maneuvers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the grading system, I-VI

A

I: barely audible (in ER)
II: faint but immediately auadible
III: easily heard, as loud as an S soudn
IV: easily heard and associated with palpable thrill
V: very loud, heard with light sthetoscope pressure
VI: audible without sthetoscope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are high pitched murmurs caused by

A

Large pressure gradients, better heard with diaphragm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Valsalva and standing effect on preload

A

Decrease preload, which decreases murmurs in regurgitation, stenosis and ventricular septal defects but increases them in HOMC and MVP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Leg raise and squatting effect on preload

A

Increase preload, which increases murmurs in stenosis, regurgitation and ventricular septal defects but decreases them in HOMC and MVP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hand gripping effect on afterload

A

Increases afterload, which decreases murmur in AS but increases them in AR, MR, VSD. Decreases also in HOCM and MVP.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe systolic ejection murmurs

A

Aortic or pulmonic valve stenosis.
Begins shortly after S1 and terminates before or at S2.

Crescendo-decrescendo. Later peak = severe stenosis.

22
Q

What is an innocent systolic murmur?

A

Benign, resulting from increased systolic flow across normal aortic and pulmonic valves. Disappears when patient sits upright.

23
Q

What is a pansystolic/holosystolic murmur and what typically causes it?

A

Mitral valve regurgitation.
Murmur is best heard at the apex, is high pitched and blowing in quality. Often radiates towards left axilla. Intensity does not change with respiration. Can extend beyond S2.

24
Q

How does inspiration change the murmur heard in tricuspid valve regurgitation?

A

Intensity of murmur increases with inspiration.

25
Q

Characteristics of murmurs heard with VSD

A

Smaller VSD = greater turbulence and louder murmur

26
Q

What causes a late-systolic murmur, typically?

A

Mitral valve prolapse. Usually murmur is preceded by a mid-systolic click.

27
Q

Early diastolic murmurs characteristics

A

Aortic or pulmonic regurgitation, decrescendo and terminates before next S1. High-pitched.

Pulmonic: intensity increases with inspiration.

28
Q

Mid- to late- diastolic murmurs characteristics

A

Due to stenotic mitral or tricuspid valve.
If the murmur is prolonged: severe.
Preceded by an opening snap after S2.

Small peak when the atrium contracts right before S1.

Low pitched

29
Q

Why can systolic murmur in mitral regurgitation be accompanied by additional diastolic murmur in advanced MR?

A

Because this causes an increased flow during diastole.

30
Q

Condition in which there is a continuous murmur

A

Patent ductus arteriosus (communication between aorta and pulmonary artery).

Due to persistent pressure gradient across two structures.

Murmur hits its peak at S2.

31
Q

What is a to-and-fro murmur?

A

Patient with both aortic stenosis and regurgitation. It is not considered a continuous murmur.

32
Q

Requirements for appropriate BP cuff size

A

Wide: 40% arm
Length: 80% arm

33
Q

Small cuff = overestimation or underestimation of BP?

A

Over.

34
Q

Loose cuff = overestimation or underestimation of BP?

A

Over.

35
Q

Brachial artery below heart = over or underestimation of BP?

A

Over.

36
Q

Brachial artery above heart = over or underestimation of BP?

A

Under.

37
Q

Why do we always start with palpation when taking the BP?

A

Because of the auscultatory gap.

38
Q

How many BP measurements to take to have an accurate one?

A

Guidelines: 5, take last 1.
Reality: 3, take last 1.

39
Q

Disease taken into account when diagnosing HTN

A

Diabetes

40
Q

Normal BP response to orthostasis

A

sBP drops slightly, dBP rises slightly

41
Q

Abnormal BP response to orthostasis

A

sBP drops >20 mm Hg
dBP drops >10 mm Hg

42
Q

Which vein do we take for jugular vein pressure and why?

A

Internal jugular vein because:

  1. Not valved
  2. Direct line with RA.
43
Q

Where does internal jugular vein lie?

A

Deep to the sternomastoid. Not directly visible.

44
Q

What does JVP reflect?

A

Right heart pressure.

45
Q

How to incline the bed to measure JVP if we anticipate hypovolemia vs hypervolemia

A

Hypovolemia: head at 0 degrees
Hypervolemia: head at 60-90 degrees.

46
Q

How to visually distinguish between IJV and carotid?

A
  1. IJV: collapses in systole and extends in diastole. Carotid = opposite.
  2. IJV height of pulsations drop as patient becomes upright. Unchanged in carotid.
  3. IJV heigh of pulsations fall with inspiration. Unchanged in carotid.
  4. 2 pulsations in IJV vs 1 in carotid.

Also, IJV is not palpable vs carotid is.

47
Q

What is considered elevated JVP?

A

> 3-4 cm above sternal angle or >8-9 above RA

48
Q

What does rise in height of JVP with inspiration indicate?

A

Lack of RV compliance.

49
Q

What is the abdominojugular reflux?

A

Pressure on the abdominal muscles for at least 10s.

Sustained rise in JVP of >3 cm for at least 15s is a positive response.

50
Q

What is the apical impulse?

A

Palpation of the apex.
Most cases = point of maximal impulse.

We assess amplitude and duration. Sustained = hypertrophy.

51
Q

Palpation of the right ventricular area indications.

A

High amplitude but not duration: chronic RV volume overload.

High amplitude and duration: chronic RV pressure overload.

BLOCK C (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions