Murmurs

Question 1

S1

Answer 1

closure of AV valves

Question 2

AV valves

Answer 2

mitral and tricuspid

Question 3

S2

Answer 3

closure of SL valves

Question 4

SL valves

Answer 4

aortic and pulmonic

Question 5

systolic ejection, crescendo-decrescendo mumur
radiates to carotid artery w/ narrow pulse pressure that is mid-systolic

Answer 5

aortic stenosis

Question 6

blowing decrescendo rumbling murmur, high pitch no radiation

Answer 6

aortic regurg

Question 7

rumbling decrescendo mid-diastolic w/ opening snap mumumur and no radiation

Answer 7

mitral stenosis

Question 8

holocystolic blowing murmur radiates to left axilla

Answer 8

mitral regurg

Question 9

crescendo- decresendo murmur heard at the left upper sternal border; systolic ejection murmur

Answer 9

pulmonic stenosis

Question 10

high pitched decresendo mumur

Answer 10

pulm regurg

Question 11

soft opening, scratching rumble w/ increased JVD murmur?

Answer 11

tricuspid stenosis

Question 12

holocystolic murmur high pitched blowing

Answer 12

tricuspid regurg

Question 13

What are the midsystolic murmurs?

Answer 13

1. aortic stenosis
2. pulmonic stenosis
3. atrial septal defect
4. HOCM

Question 14

What are the holosystolic murmurs?

Answer 14

1. mitral regurgitation
2. tricuspid regurgitation
3. VSD

Question 15

What is the late systolic murmur?

Answer 15

mitral valve prolapse (lapse = late)

Question 16

what are the early diastolic murmurs?

Answer 16

1. aortic regurgitation
2. pulmonic regurgitation
3. austin-flint

Question 17

what is the mid/late diastolic murmur?

Answer 17

1. mitral stenosis
2. tricuspid stenosis

Question 18

rumbling-diastolic (mid-late) best heard at the apex, severe aortic regurg

Answer 18

austin- flint murmur

Question 19

what murmurs increase and decrease with inspiration?

Answer 19

right increase
left decrease

Question 20

what murmurs increase and decrease with squatting?

Answer 20

increase MS, AS, aortic insufficency
decrease Hypertrophic cardiomyopathy

Question 21

what increases and decreases with standing?

Answer 21

increases hypertrophic cardiomyopathy
decreases aortic stenosis, MR

Question 22

what increases and decreases with valsalva?

Answer 22

increases hypertrophic cardiomyopathy, MVP
decreases almost all

Question 23

What is HFrEf?

Answer 23

LV systolic dysfunction with S3 gallop
impaired contractility
increased diastolic
EF< 40 %

Question 24

What is HFpEF?

Answer 24

LV filling and relaxation impaired
EF> 40%
S4 gallop

Question 25

What are all the NYHA classes?

Answer 25

Class 1: no limitations of physical activity Class 2: slight limitations, sxs w/ moderate exertion class 3: mod. limitations, sxs w/ mild exertion class 4: unable to carry out any physical activity w/o discomfort

Question 26

Right sided HF s/s

Answer 26

systemic ascites, hepatomegally, decreased bowel perfusion JVD

Question 27

S/S of left sided heart failure

Answer 27

think pulmonary crackles at the lung base dullness to percusion JVD, displaced PMI peripheral edema orthopnea chronic cough

Question 28

What is the treament guideline for heart failure?

Answer 28

ARNI (entresto) ACEI (pril)/ arbs (sartan) BB SGT2-I ( jardiance/ forxiga) MRA (spironolactone) loop diuretics

Question 29

What are the two IV medications for heart failure?

Answer 29

Iv dobutamine and Iv milrnone

Question 30

Explain all of dilated cardiomyopathy? causes? S/S? PE? DX? TX?

Answer 30

Causes: " Im mad my pump failed" Idiopathic, myocarditid, alcohol, drugs, medications, pregnancy, family inherited S/S: extertional intolerance PE: pulmonary rales, S3 Gallop, periheral edema, ascites TX: underlying causes + HErEF treatment

Question 31

Explain all of Hypertrophic cardiomyopathy? causes? S/S? PE? DX? TX?

Answer 31

Causes: genetic, diastolic dysfunction asymmetrical growth - left ventricle larger s/s: syncope (SOB w/ activity, exertional fatigue) PE: murmur decreased w/ squatting or hadgrips murmur increased w/ valsalba + rapid movement EKG: LVH echo (gold standard): EF < 60 % TX: BB

Question 32

Explain all of Restrictive cardiomyopathy? causes? S/S? PE? DX? TX?

Answer 32

systolic and diastolic dysfunction Causes: amyloidosis (mc) S/S: SOB, fatigue, peripheral edema, hepatomegally Dx: echo -> small ventricles that are thick or rigid w/ pulmanary HTN EF: -> 20- 50 % Tx: Diuretics + bp

Question 33

Explain all of stress cardiomyopathy? causes? S/S? PE? DX? TX?

Answer 33

Tako-tsubo syndrome ( broken heart syndrome) EKG: ST-elevation w/ deep anterior T wave inversion, LV wall thickening Tx: similar to MI -> ASA, BB, ACEI

Question 34

Aortic Stenosis Triad?

Answer 34

1. Chest pain 2. Dyspnea 3. Syncope