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Flashcards in Murmurs Deck (23)
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1
Q

What are the basics identifiers of heart murmurs?

A
  • Grade I-VI (II, III most common)
  • Systolic vs diastolic
  • Where heard best
  • Does it radiate
2
Q

What are the main characteristics of aortic stenosis?

A
  • Early to systolic murmur
  • Crescendo-decrescendo, possible ejection click
  • Heard best over base and tends to radiate to carotids
  • late stages maybe have decreased systolic pressure and slow carotid upstroke
3
Q

What are the eitology, sx’s and treatment for As?

A
  1. Degenerative calcific, rheumatic or congenital bicuspid
  2. Angina, syncope and dyspnea on exertion SAD
  3. Valve replacement, ballon valvuloplasty in children and young adults
  • stenosis can cause micro-angiopathic hemolytic anemia by mechanical shearing of RBC’s
4
Q

What is the pathophys of AS?

A

Shouldn’t be a pressure gradient from LV to aorta. Thus severe dz suggest pressure gradient of over 50mmHg

  • another way is valve area (1/3 valve area means severe dz)
  • can lead to LV hypertrophy and HF
5
Q

how does one discriminate between AS and rheumatic Heart Dz?

A

In rheumatic the Aortic stenosis is caused by fusion of aortic valve commissures.

  • AS its caused by fibrosis
  • Rheumatic ALWAYS has mitral stenosis involvement with AS.
6
Q

What are some characteristics of mitral insufficiency?

A

Holosystolic “blowing murmur”

  • apex and radiates to axilla
  • 5th intercostal space
  • Louder when squatting and expiration
7
Q

What is the etiology of MR?

A
  • ACUTE RHD
  • Congenital
  • Acute MI with papillary muscle dysfunction
  • Endocarditis
  • Calcification with age
  • MV prolapse
  • LV dilation (pulls valve apart)
8
Q

What are some consequences of mitral regurge?

A

Left atrial enlargement and pulmonary edema

  • Acute SOB
  • Fatigue
  • A-fib
9
Q

What is the treatment for mitral regurge?

A

Treat CHF medically and a-fib

- Surgery

10
Q

Why does squatting and expiration lead to louder MR murmur?

A

Squatting increases systemic tension and thus increases LV tension and decreased LV emptying

  • Expiration moves blood from lungs to left atrium leading to increase SV
11
Q

What are some characteristics of mitral stenosis?

A

Diastolic murmur heart best at apex with patient laying on left side

  • Low pitched rumble
  • Opening snap
  • Caused by chronic RHD and rarely congenital
12
Q

Symptoms of MS? Treatment?

A

Dyspnea with exertion and cough

  • hemoptysis (bloody cough)
  • Arterial embolism
  • Antibiotic prophylaxis, CHF, A-fib and valve replacement is less than 1.0 cm2
13
Q

What is the pathophys of MS?

A

4-6 cm2= normal orfice

  • Pulmonary HTN
  • Pulmonary edema
  • mural thrombi
  • Left atrial pressure
  • Resultant Right ventricular failure
14
Q

what are some characteristics of aortic insufficiency?

A

High pitched diastolic murmur at base

  • Best heart when pt is sitting
  • Water hammer pulse
  • Increased pulse pressure
  • Louder and longer with increased severity
  • Decrescendo murmur
15
Q

What are the causes of AI?

A
  • Rheumatic hd
  • endocarditis
  • Trauma
  • Congenital (marfans) or bicuspid

Most commonly from aortic root dilation by syphilitic aneurysm or aortic dissection

16
Q

What are the sx’s and treatment for AI?

A

Asymptomatic for years

  • Palpitations while laying down
  • Exertional dyspnea and orthopnea
  • Angina and CHF
  • Increase SV
  • Pulsatile nail bed
  • Eccentric hypertrophy of LV

Treat: asx until myocardial dysfunction but after valve replacement myocardial dysfunction does not return

17
Q

What is mitral prolapse?

A

Mid to late systolic click (softer with squatting)

  • Followed by high pitched late systolic murmur
  • usually benign
  • Treat with reassurance or replacement
18
Q

What are the causes and consequences of MVP?

A

Congenital or genetic
Very common
Females from 14-30.

Myxoid degeneration of posterior leaflet

  • Chordeae rupture
  • ED or Marfans
19
Q

What are some MVP complications?

A
  • Infective endocarditis
  • arrhythmias
  • severe MR
20
Q

What is tricuspid stenosis?

A

Rare in developed

  • Rheumatic and ass with MS
  • Giant A wave in neck
  • Diastolic murmur heard at lower left sternal border and xiphoid
21
Q

What is tricuspid regurge?

A

Functional from RV dilation
- Right HF
Holosystolic murmur at LLSB
Prominent V waves in neck

22
Q

How about pulmonic stenosis?

A

Preceded by ejection click

  • midsystolic murmur at left 2nd and 3rd interspaces
  • benign in younger people
23
Q

Innocent murmurs?

A
  • Always systolic ejection in nature
  • no evidence of physiologic anomalies
  • Grade I or II
  • No thrills or radiation
  • End well before S2
  • 30-50% children