Flashcards in Murmurs Deck (23):
What are the basics identifiers of heart murmurs?
-Grade I-VI (II, III most common)
-Systolic vs diastolic
-Where heard best
-Does it radiate
What are the main characteristics of aortic stenosis?
-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
What are the eitology, sx's and treatment for As?
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
What is the pathophys of AS?
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
how does one discriminate between AS and rheumatic Heart Dz?
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.
What are some characteristics of mitral insufficiency?
Holosystolic "blowing murmur"
- apex and radiates to axilla
- 5th intercostal space
- Louder when squatting and expiration
What is the etiology of MR?
- ACUTE RHD
- Acute MI with papillary muscle dysfunction
- Calcification with age
- MV prolapse
- LV dilation (pulls valve apart)
What are some consequences of mitral regurge?
Left atrial enlargement and pulmonary edema
- Acute SOB
What is the treatment for mitral regurge?
Treat CHF medically and a-fib
Why does squatting and expiration lead to louder MR murmur?
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
What are some characteristics of mitral stenosis?
Diastolic murmur heart best at apex with patient laying on left side
- Low pitched rumble
- Opening snap
- Caused by chronic RHD and rarely congenital
Symptoms of MS? Treatment?
Dyspnea with exertion and cough
- hemoptysis (bloody cough)
- Arterial embolism
- Antibiotic prophylaxis, CHF, A-fib and valve replacement is less than 1.0 cm2
What is the pathophys of MS?
4-6 cm2= normal orfice
- Pulmonary HTN
- Pulmonary edema
- mural thrombi
- Left atrial pressure
- Resultant Right ventricular failure
what are some characteristics of aortic insufficiency?
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
What are the causes of AI?
- Congenital (marfans) or bicuspid
Most commonly from aortic root dilation by syphilitic aneurysm or aortic dissection
What are the sx's and treatment for AI?
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
What is mitral prolapse?
Mid to late systolic click (softer with squatting)
- Followed by high pitched late systolic murmur
- usually benign
- Treat with reassurance or replacement
What are the causes and consequences of MVP?
Congenital or genetic
Females from 14-30.
Myxoid degeneration of posterior leaflet
- ED or Marfans
What are some MVP complications?
What is tricuspid stenosis?
Rare in developed
- Rheumatic and ass with MS
-Giant A wave in neck
- Diastolic murmur heard at lower left sternal border and xiphoid
What is tricuspid regurge?
Functional from RV dilation
- Right HF
Holosystolic murmur at LLSB
Prominent V waves in neck
How about pulmonic stenosis?
Preceded by ejection click
- midsystolic murmur at left 2nd and 3rd interspaces
- benign in younger people