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1

Aids: Usually decreasing or disappears on sitting

Innocent Murmurs

2

result from turbulent blood flow, probably generated by ventricular ejection of blood into the aorta from the left and occasionally the right ventricle.

Innocent Murmur

3

Very Common in children and young adults-may also be heard in older people. There is not lying cardiovascular disease

innocent murmurs

4

similar to innocent murmurs, possible signs of a likely cause, turbulence due to a temporary increase in blood flow in predisposing conditions such as anemia, pregnancy, fever, and hyperthyroidism

Physiologic Murmurs

5

the most common kind of heart murmur

midsystolic click

6

three types of midsystolic clicks

innocent - without detectable physiologic or structural abnormality

7

midsystolic murmurs tend to peak _____ and usually stop _______

near mid-systole, usually stop before S2

8

Aids: heard best with the patient sitting and leaning forward

Aortic Stenosis

9

A2 decreases as this worsens. A2 may be delayed and merge with P2 _ single S1 on expiration or paradocixcal S2 split. Carotid upstroke may be delayed with slow rise and small amplitued. Hypertrophied left ventricle may _ sustained apical impulse and an S4 from decreased compliance

...

10

Aids: Decreases with squatting, increases with straining down from Valsava and standing

Hypertrophic Cardiomyopathy

11

associated with unusually rapid ejection of blood from the left ventricle during systole. Outflow tract obstruction of flow may coexist. Accompanying distortion of the mitral valve may cause mitral reguritation

massive ventricular hypertrophy

12

Quality: often harsh

Pulmonic Stenosis

13

In severe pulmonic stenosis ____ is widely split, and ____ is diminished or inaudible. An early pulmonic ejection sound is common. May hear a right sided ____. Right ventricular impulse often increased in amplitude and sustained

S2, P2, S4

14

______ impairs flow across the valve, increasing right ventricular afterload. Congenital and normally found in children.

Pulmonic valve stenosis

15

In an ______, the systolic murmur from pathologically increased flow across the pulmonic valve may mimic pulmonic stenosis

atrial septal defect

16

Diastolic Murmurs, two types

Aortic regurgitation and mitral stenosis

17

Aids: The murmur is heard best with the patient sitting, leaning forward, with breath held after exhalation

Aortic Regurgitation

18

An ejection sound may be present. An S3 or S4, if present, suggusts sever regurgitation

Aortic reguritation

19

Progressive changes in the apical impulse for Aortic Regurgitation include:

increased amplitude, displacement laterally and downward, widened diameter, and increased duration

20

For Aortic Regurgitation, the pulse pressure ______ and the arterial pulses are ______. A midsystolic flow murmur or an Austin Flint murmur suggests large regurgitant flow

Increases,

21

(Diastolic / Systolic) murmurs almost always indicate heart disease.

Diastolic

22

_______ murmurs signify regurgitant flow through an incompetent semilunar valve, more commonly, the aortic

Early descresendo diastolic

23

____ mumurs in mid or late _____ suggest stenosis of an AV valve, usually the mitral

Rumbling diastolic, diastolic

24

Mechanism of aortic reguritation

The leaflets of the aortic valve fail to close completely during diastole, and blood reguritates from the aorta back into the left ventricle. Volume overload on the left ventricle resules.

25

Two other murmurs associatied with Aortic Regurgitation

mid systolic murmur from the resulting increased forward flow across the aortic valve and a mitral diastolic (Austin Flint) attributed to diastolic impingement of the regurgitant flow on the anterior leflet of the mitral valve

26

Aids: placing the bell exactly on the apical impulse turning the patient into a LLD position and mild exercise, better in exhalation

Mitral Stenosis

27

S1 is accentuated and may be palpable at the apex. An opening snap often follows S2 and initiates the murmur

Mitral Stenosis

28

If pulmonary hypertension develops, P2 is acentuated, and the right ventricular impuls becomes palpable.

Mitral Stenosis

29

Mitral regurgitation and aortic valve disease may be associated with

Mitral Stenosis

30

When the leaflets of the mitral valve thicken, stiffen, and become distorted from the effects of rheumatic fever the ...

mitral valve fails to open sufficiently in diastole

31

two components of mitral stenosis murmur

middiastolic (during rapid ventricular filling)

32

three examples of cardiovascular sounds with both systolic and diastolic components

venous hum, pericardial friction rub, patent ductus arteriosus

33

a benign sound produced by turbulance of blood in the jugular veins

venous hum

34

produced by inflammation of the pericardial sac

pericardial friction rub

35

a congenital abnormality in which an open channel persists between the aorta and pulmonary artery

patent ductus arteriosus

36

____ mumurs begin in systole and extend through S2 into all or part of diastole

continuous

37

Pitch: low (better heard with bell)

Venous hum

38

Pitch: High (heard better with the diaphram)

Pericardial Friction Rub

39

Pitch: Medium

Patent Ductus Arteriosus