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Flashcards in more murmur Deck (73):
1

Classic exertional pain, pressure, or discomfort in the chest, shoulder, back, neck, or arm in angina pectoris, seen in 50% of patients with this

myocardial infarction

2

atypical descriptors in myocardial infarction

cramping, grinding, pricking (rarely is tooth or jaw pain)

3

Unstable angina, non-ST elevation MI, and ST elevation infarction

clinical syndromes caused by acute MI

4

Anterior chest pain, tearing or ripping, often radiating into the back or neck is....

acute aortic dissection

5

Only WHAT can be reliably identified at the bedside during sign or symptoms of irregular heart action

atrial fibrillation

6

Sudden dyspnea can be seen in

pulmonary embolus, spontaneous pneumothorax, anxiety

7

IN what heart conditions might you see orthopnea

in left ventricular heart failure or mitral stenosis

8

PND or paroxysmal nocturnal dyspnea can be indicative of

left ventricular heart failure or mitral stenosis

9

Dependent edema appears in what part of the body

lowest body parts - feet and lower legs when sitting or sacrum when bedridden (causes may be cardiac, nutritional, or positional)

10

Periorbital puffiness and tight rings around the eyes are indicative of what

nephrotic syndrome

11

Venous pressure may appear elevated on expiration in this condition

obstructive lung disease

12

Increased pressure of JVP suggests most commonly....

R-sided congestive heart failure

13

An elevated JVP is 98% specific for what?

an increased left ventricular end diastolic pressure and low left ventricular ejection fraction

14

Unilateral distention of the external jugular vein is usually caused by

local kinking or obstruction

15

Causes of decrease carotid pulsations...

decreased stroke volume and local factors in the artery such as atehrosclerotic narrowing or occlusion

16

Pressure on the carotid can cause what?

reflex drop in pulse rate or blood pressure

17

Small, thready, or weak carotid pulsations are found in....

cardiogenic shock, bounding pulse in aortic insufficiency

18

What happens to the carotid pulse wave (or speed of upstroke) in aortic stenosis?

Delayed

19

Variations in carotid pulse amplitude is seen in

pulsus alternans, bigeminal pulse (beat-to-beat variation), parodoxical pulse (respiratory variation)

20

A murmur-like sounds of vascular rather than cardiac origin is called

Bruit

21

A carotid bruit radiating over the neck is a...

aortic valve murmur

22

The prevalence of assymtpomatic carodtid bruits increases with what?

Age. Reaching 8% of people over 75 y/o (increased risk of ischemic heart disease and stroke)

23

Low-pitched extra sounds such as S3, opening snap, diastolic rumble over the Apical Impulse is what?

Mitral Stenosis

24

Soft drescendo diastolic murmur while patient is leaning forward with your diaphragm over the left sternal border is what?

Aortic insufficiency (regurg)

25

S1 is normally louder than S2 at the apex, if it is decreased, it could be

first-degree heart block

26

S2 is normally louder than S1 at the base of the heart. If it is decreased, it could be

aortic stenosis

27

Detection of thrills upon palpation in addition to loud, harsh, or rumbling murmurs may be present in what?

aortic stenosis, patent ductus arteriosus, ventricular septal defect. (Less commonly mitral stenosis)

28

A heart situated on the R-side of the body would be called

dextrocardia. You would be sure to check apical impulse on the R-side of the patient

29

Pregnancy or a high left diaphragm may displace the apical impulse which direction

upward and to the Left

30

Lateral displacement of the apical impulse can be seen in these conditions

CHF, cardiomyopathy, ischemic heart disease. (deformities of thorax and mediastinal shift may also cause it)

31

If pt is in the L lateral decubitus position with a diffuse PMI w/diameter >3cm, what does this indicate?

Left ventricular enlargement

32

Increase PMI amplitude can reflect?

Hyperthyroidism, severe anemia, pressure overload of L ventricle (as in aortic stenosis), or volume overload of the L ventricle (as in mitral regurgitation)

33

A sustained high-amplitude impulse over PMI suggests

L ventricular hypertrophy from pressure overload (as in HTN). If such a long duration impulse occurs laterally, consider volume overload

34

A sustatined low-amplitude (hypokinetic) impulse may result from

dilated cardiomyopathy

35

A brief middiastolic impulse indicates what?

S3

36

An impulse just before the systolic apical beat itself indicates what?

S4

37

A marked increase in amplitude w/little or no change in duration occures in what?

chronic volume overload of the R ventricle (as in from an atrial septal defect)

38

An impulse w/increased amplitude and duration occurs in what?

w/ pressure overload of the R ventricle as in pulmonic stenosis or pulmonary HTN

39

In obstructive pulmonary disease, hyperinflated lung may prevent palpation of what?

an enlarged right ventricle in the L parasternal area. The impulse is felt easily, high in the epigastrium where heart sounds are also often heard best

40

The 2nd L interspace overlies what?

The pulmonary artery

41

A prominnet pulsation here often accompanies dilatation or increased flow in the pulmonary artery.

Pulmonic or L 2nd ICS

42

A palpable S2 over the L 2nd ICS suggests increased pressure in the?

pulmonary artery (as in pulmonary HTN)

43

The 2nd R interspace overlies what?

Aortic outlfow tract (I realize she won't ask us this but if you know landmarks = easier to figure out abnormalities)

44

A palpable S2 over the aortic area or R 2nd ICS suggests?

systemic HTN; a pulsation here suggests a dilated or aneurysmal aorta

45

What may have a hypokinetic apical impulse that is displaced far to the Left?

A markedly dilated failing heart

46

What may make the apical impulse undectable?

A large pericardial effusion

47

A L-sided decubitus position accentuates what?

S3, S4, mitral murmurs (especially MITRAL STENOSIS)

48

A sitting and leaning forward position accentuates what?

aortic murmurs (especially AORTIC REGURGITATION)

49

Expiratory splitting between S2 suggests?

Pathology! (It's normal upon inspiration) could be from delayed closure of the pulmonic valve (pulmonic stenosis or R bundle branch block) in WIDE SPLITTING, or atrial septal defefct and R ventricular failure in FIXED SPLITTING

50

Persistent splitting results from

delayed closure of the pulmonic valve or early closure of the aortic valve

51

A systolic click is the most common sound between S1 and S2, heard in?

MVP

52

Diastolic murmurs usually indicate what?

Valvular heart disease

53

Diastolic murmurs happen between?

S2 and S1

54

What type of murmur begins typically arise from blood flow across the semilunar valves?

Midsystolic (see pg 384-385 for etiology)

55

What type of murmur often occur with regurgitant flow across the AV valves?

Pansystolic (see pg 383)

56

This is the murmur of mitral valve prolapse and is often, not always preceded by a systolic click...

A late systolic murmur

57

What type of murmurs accompany regurgitant flow across incompetent semilunar valves?

Early diastolic murmurs (think immediately after S2 without a discernible gap)

58

What type of murmurs reflect turbulent flow across the AV valves?

middiastolic and presystolic murmurs

59

This presystolic murmur is a crescendo between S2 and S1

mitral stenosis

60

This early diastolic murmur is a decrescendo

aortic regurgitation

61

This midsystolic murmur is a crescendo-decrescendo pattern

aortic stenosis (and innocent flow murmurs)

62

A loud murmur that often radiates up into the neck (esp on the R side)

arotic stenosis

63

Emphysematous lungs may do what to a murmur?

May diminish the intensity (in thin folks, the degree of turbulence may be louder than an obese person)

64

A medium-pitched, grade 2/6, blowing decresendo diastolic murmur, heard best in the 4th L interspace, with radiation to the apex is what?

Aortic Regurgitation

65

A 60 y/o person w/angina, you hear a harsh 3/6 mid-systolic crescendo-descrendo murmur in the R 2nd interspace radiating to the neck is what?

Aortic stenosis (or possibly aortic sclerosis, a dilated aorta, or increased flow across a normal valve)

66

If after you hear a murmur 2/6 in the 2nd and 3rd L interspace and you begin to evaluate any splitting, or ejection sounds while the patient is sitting up, but all is normal...you suspect

an innocent or functional murmur w/no pathologic significance.

67

This is the only murmur that increases in intensity during the Valsave manuever (strain phase)

Hypertrophic cardiomyopathy

68

This murmur decreases intensity during the Valsave maneuver

Aortic stenosis

69

Squatting (or release of the Valsava) decreases intensity in

Hypertrophic cardiomyopathy

70

Squatting decreases prolapse of this murmur

MVP

71

Alternately loud and soft Korotkoff sounds or a sudden doubling of the apparent heart rate as the cuff pressure declines indicates

pulsus alternans (almost always indicates L-sided heart failure)

72

A difference between Korotkoff sounds of > 10mmHg indicates

a paradoxical pulse and suggests pericardial tampodnade (possible constrictive percarditis but most commonly obstructive airway disease) see p 377

73

If the JVP is >5cm above the sternal angle and HOB is >30 degrees, you find that there are brisk carotid upstrokes, a bruit is heard over the L carotid artery, and the PMI is diffuse + high pitched harsh 2/6 holosystolic murmur best heard at the apex radiating to the axilla, what 2 things can you suspect?

Suggests CHF w/volume overload and Mitral Regurgitation