(L4) Cardiac Sounds & Murmurs (Stewart)

Question 1

What is Erb’s point?

Answer 1

3rd ICS lateral to LSB

Question 2

What does S2 mark end of?

Answer 2

Systole

Question 3

S3 heart sound is listened to with the __ & occurs after __ during ___. It is __ pitched.

Answer 3

S3 heart sound is listened to with the bell occurs after S2 during diastole. It is low pitched.

Question 4

What is a systolic murmur?

Answer 4

• occurs during ventricular systole

Question 5

What is diastolic murmur?

Answer 5

Occurs during atrial systole

Question 6

KNOW

Question 7

S1 occurs between

Answer 7

Closing of mitral valve to opening of aortic valve

Question 8

As Left vent pressure drops, it is the physiological cause for _____.

(know)

Answer 8

aortic valve closure

Question 9

Describe a continuos murmur

Answer 9

• Begins in systole and extends into all or part of diastole

Question 10

Position for listening for a aortic regurgitation?

Answer 10

Patient leans forward

Question 11

Position for detecting mitral stenosis?

Answer 11

• Left lateral decubitus

Question 12

What is being heard in an aortic stenosis?

Answer 12

Disrupted forward flow through stenotic A valve

Question 13

What is being heard in a pulmonic stenosis?

Answer 13

Disrupted foward flow through stenoitc P valve

Question 14

What is being heard with Tricuspid regurgitation?

Answer 14

• Backflow through semi closed T valve

Question 15

What is being heard with Mitral regurgitation

Answer 15

backflow through a semi closed M valve

Question 16

Describe tricuspid and mitral stenosis?

Answer 16

They are ventricular diastolic murmurs

• Triscupid stenosis is disrupted forward flow through T valve
• Mitral is disrupted forward flow through M valve

Question 17

Describe pulmonic and aortic regurgitations.

Answer 17

• Ventricular diastolic murmurs
• Backflow against semi closed P valve
• Backflow against semi closed A valve

Question 18

• Aortic stenosis- Old valves are SAD. What is SAD?

Answer 18

• Syncopal
• Angina
• Dyspnea

Calcified aortic valve, crescendo-decrescendo, radiates UP to the carotids

Question 19

Aortic regurgitation, how to remember? What is it assoc with?

Answer 19

• ARR there she BLOWS
• Early blowing diastolic murmur
• associated with:
  
  • CT disorders
  • Marfan’s syndrome
  • Head bobbing
  • Water hammer pulse
  • Femoral bruits

Question 20

what type of murmur is triscupid regurgitation? Associated with?

Answer 20

Holosystolic

• assoc with hx of IV drug abuse
• its the murmur you get if you want to TRI drugs

Question 21

78 yo male in ED presents with SOA and chest pain on exertion for past three months. On PE you hear II/VI systolic ejection murmur over the apical area of the heart. Where would the valvular pathology be located?

Answer 21

• Mitral valve stenosis

Question 22

Mitral stenosis, way to remember and assoc with?

Answer 22

• The Operating System is MicroSoft
• There is an opening snap
• Associated with hisotry of rheumatic fever

Question 23

What is mitral valve prolapse?

Answer 23

• Midsystolic click
• Clinical presentation of young woman with psychiatric hx
• Can be due to Myxomatous valvular pathology in stem question
• See the MVPand everything willClick.

Question 24

Mitral regurgitation? POSSIBLE TEST QUESTION

Answer 24

• Rheumatic heart disesase assoc with this
• Described as holocystolic plateau murmur
• Best heard at apex radiating to axilla
• S1 diminished
• Loud and blowing

Question 25

In most cases as preload increases the murmur will get \_\_\_\_.

Answer 25

In most cases as preload increases the murmur will get **_louder_**.

Question 26

In most cases as preload decreases the murmur will get \_\_\_.

Answer 26

In most cases as preload decreases the murmur will get **_softer_**

Question 27

During inspiration what happens to right heart sounds?

Answer 27

Right sideed murmur will get louder (T &P)

Question 28

With expiration what happens to murmurs on left heart?

Answer 28

Louder M& A

Question 29

Hypertropic obstrutive cardiomyopathy difference in increasing and decreasing preload?

Answer 29

* Increase in preload decreases an aortic murmur by pushing the septum away from the aortic outflow tract allowing blood to be easier ejected * Decrease in preload causes increasing aortic murmur due to less blood to push outflow track open obstructing and disrupting blood flow

Question 30

How does MVP change preload?

Answer 30

* Leaflets of MV prolapse into left atria under normal pressure and cause disruption of blood flow * Increase in preload improves the midsystolic click heard by allowing the prolapsed leaflets to return to normal orientation

Question 31

Fhx of HOCM? Specific maneuvers to ID it?

Answer 31

* Sudden cardiac death at young age * Louder with decreased preload & afterload * Softer with increased preload and afterload

Question 32

How does afterlaod impact murmurs?

Answer 32

* Increased afterload the murmur gets louder * Decreased afterload the murmur gets softer

Question 33

In MVP and HOCM how does afterlaod impact the murmur?

Answer 33

* Increased afterlaod = soft * Decreased afterlaod = louder