Murmurs

Question 1

Which valves cause most disease

Answer 1

Left valves, cause the most disease

Due to higher pressure

Question 2

Why is function of valves

Answer 2

Ensure that blood is flowing in one direction

Question 3

Stenosis is what

Answer 3

Narrowing of the valve

Question 4

Regurgitation is what

Answer 4

Deformed or damaged valves, which allow backflow of blood

Question 5

Why does left side of the heart cause most disease in adults

Answer 5

Higher pressure, and therefore there is more turbulence,

Question 6

What is causing murmur, valvular heart disease

Answer 6

Infections, such as rheumatic fever, or endocarditis,

Heart diseases, such as coronary artery disease

Autoimmune diseases such as rheumatoid arthritis

Question 7

What to do when u first hear a murmur

Answer 7

Assess the location of where it is heard

How loud is it

Does it radiate

Does it change with different positions

Does it change with other maneuvers, breathing or squatting

Question 8

Two main heart sounds are

Answer 8

S1; and s2 referred to as lub dub

Question 9

S1 Is the closure of the __ valves

Answer 9

AV MITRAL AND TRICUSPID

Question 10

S2 is closure of the ______ valves

Answer 10

Semilunar

Question 11

S3 heart sound is heard when

Answer 11

In early diastole just after S2

Question 12

Why does an S3 sound occur

Answer 12

From blood rapidly hitting the left ventricle when filling, and is a vibration sound

Question 13

MCC Cause of S3 in elderly is

Answer 13

CHF

Question 14

What are other causes of S3

Answer 14

Can be due to dilated cardiomyopathy
**CHF
Or pregnancy

Question 15

S4 is heard best in _____ diastole before S1

Answer 15

Late

Question 16

What causes S4 heart sound

Answer 16

Results from a forceful atrial contraction, pushing blood into stiff left ventricle

Question 17

True or false S4 is always an abnormal finding

Answer 17

True

Question 18

If u hear S4 heart sound what might u be suspecting

Answer 18

Hypertension or acute MI causing stiff left ventricle

Question 19

Systolic heart murmurs are heard between

Answer 19

S1 and S2

Question 20

Systolic murmur can be ejection murmur ______or _______regurgitant murmur _____or _____

Answer 20

Aortic or pulmonic stenosis

Mitral or tricuspid regurgitation

Question 21

Increase venous return increase intensity of most murmurs except for

Answer 21

Hypertrophic cardiomyopathy and mitral valve prolapse

The mvp hates conforming to the rule

Question 22

Diastolic murmur hears between _____ and ___

Answer 22

S2 and S1

Question 23

Diastolic murmur mnemonic

Answer 23

Ms prarts died

Mitral stenosis
Pulmonary regurgitation
Aortic regurgitation
Tricuspid stenosis

Died, diastolic

Question 24

What maneuvers increase venous return

Answer 24

Squatting
Raising legs
Inspiration

Question 25

What maneuver decrease venous return

Answer 25

Standing and valsalva maneuver

Question 26

Right sided murmurs increase with _____

Answer 26

Inspiration [RINspiration]

Question 27

Left sided murmurs ______ with inspiration

Answer 27

Decrease

Question 28

Best test to assess if pt has a murmur

Answer 28

Transthoracic (TTE) transesophageal (TEE)

Question 29

Aortic stenosis most common causes include

Answer 29

Degenerative, if patient is over 70, Age related calcification Congenital, in young less than 70 pts, symptoms occur when pt is 50-65 Infectious in underserved countries

Question 31

Most common cause of left ventricle outflow obstruction is _____

Answer 31

Aortic stenosis

Question 32

Symptoms of aortic stenosis include

Answer 32

Long asymptomatic phase Then patient can develop Syncope, Angina Dyspnea All indicates that disease has progressed

Question 33

Aortic stenosis

Answer 33

Crescendo decreschendo Mid systolic High pitch Radiates to carotid

Question 34

Aortic stenosis is heard best where

Answer 34

Right 2nd intercostal space

Question 35

What might u note on exam with aortic stenosis

Answer 35

Pulsus parvus et tardus, weak or absent pulse May feel a carotid thrill

Question 36

Aortic stenosis murmur is increased when

Answer 36

Leaning forward, sitting Squatting! Leg raise

Question 37

Complication of aortic stenosis

Answer 37

Can result in sudden death it severe

Question 38

What to educate pt on with severe aortic stenosis

Answer 38

No phycial activity

Question 39

When to refer with aortic stenosis

Answer 39

If pt is symptomatic, refer to cardiology Or severe stenosis, regardless of symptoms

Question 40

Treatment of choice for aortic stenosis is

Answer 40

Transcatheter aortic valve replacement TAVR, minimally invasive and used if calcific aortic stenosis

Question 41

Mitral stenosis what will be heard on exam

Answer 41

Low pitch mid diastolic rumble May hear a high pitched opening snap

Question 42

Where is mitral stenosis best heard

Answer 42

Best heard at the mitral area, apex of heart , pt in left lateral decubitus

Question 43

Pt with mitral stenosis other signs

Answer 43

A fib Jvd May have signs of ischemia, delayed capillary refill Mitral facies, flush due to decreased cardiac output

Question 44

On echo what will mitral stenosis show, early vs late

Answer 44

Early, may show left atrial enlargement Late mitral stenosis could show, left ventricular enlargement with left atrial enlargement

Question 45

Chest X-ray for mitral stenosis may show

Answer 45

Double density sign, left atrial enlargement

Question 46

What causes S3 heart sound

Answer 46

S3 heart sound occurs in early diastole following S2, av is open blood comes in from atria to the ventricles, and if there is too much volume it rushes in such as in CHF , this can occur in pregnancy and in trained athletes so it is not always abnormal

Question 47

When may u hear a (6) murmur, c

Answer 47

Can be heard in severe aortic stenosis

Question 48

Mid systolic murmur with a click heard at apex, (left 6th ICS) is what murmur

Answer 48

Mitral valve prolapse

Question 49

Most common complication of mitral valve prolapse is?

Answer 49

Mitral regurgitation

Question 50

MVP murmur is increased in intensity with what maneuver

Answer 50

Valsalva or standing, (decreased venous)