Murmurs/Cardiomyopathies

Question 1

Murmurs are graded 1-6. What is grade 3?

Answer 1

Murmur is louder than S1 and S2

Question 2

Murmurs are graded 1-6. What is grade 4?

Answer 2

A palpable thrill is present

Question 3

Murmurs are graded 1-6. What is grade 5 and 6?

Answer 3

5 = Heard with stethoscope half off chest
6 = Heard without stethoscope

Question 4

What 2 types of murmurs should be further evaluated?

Answer 4

1. ANY diastolic murmur
2. Systolic murmurs that are 3+ grade

Question 5

What 2 types of murmurs should be further evaluated?

Answer 5

1. ANY diastolic murmur
2. Systolic murmurs that are 3+ grade

Question 6

Certain murmurs become louder with more blood in the heart, what are 2 maneuvers to do this?

Answer 6

• Leg lift
• Squatting

Question 7

A majority of the murmurs will become louder with?

Answer 7

More blood in the heart
– leg lift or squatting

Question 8

What often causes Mitral Stenosis?

Answer 8

Rheumatic heart disease

Question 9

What will be heard with Mitral Stenosis?

Answer 9

Opening snap and diastolic rumble at the apex

Question 10

What is the unique treatment for Mitral Stenosis?

Answer 10

Balloon valvuloplasty

Question 11

What often causes Regurgitation murmurs?

Answer 11

Infection
Infarction

Question 12

What will be heard with Mitral Regurgitation?

Answer 12

Holosystolic murmur at the apex

Question 13

What can cause Mitral Regurgitation?

Answer 13

Rupture of chordae/papillae muscles

Question 14

What can cause Aortic Regurgitation?

Answer 14

Aortic Dissection

Question 15

What will be heard with Aortic Regurgitation?

Answer 15

Decrescendo rumbling diastolic murmur

Question 16

What often causes Aortic Stenosis?

Answer 16

Calcified valve from atherosclerosis/bicuspid valve

Question 17

What will be heard with Aortic Stenosis?

Answer 17

Crescendo-Decrescendo systolic murmur that radiates to the carotids

Question 18

What is the treatment for Mitral Regurgitation and both Aortic murmurs?

Answer 18

Valve replacement

Question 19

Certain murmurs become louder with less blood in the heart. How is this done?

Answer 19

Valsalva

Question 20

What murmurs will become louder with valsalva (less blood in the heart)?

Answer 20

HOCM
MVP

Question 21

What murmurs will become softer/better with more blood in the heart (leg lift/squat)?

Answer 21

HOCM
MVP

Question 22

What are the presenting signs of HOCM?

Answer 22

Young athlete with dyspnea or syncope on exertion
– (+) family history often

Question 23

What causes HOCM?

Answer 23

Sarcomere dysfunction that leads to septal hypertrophy and LV outflow obstruction

Question 24

What will be heard with HOCM?

Answer 24

Aortic Stenosis murmur
= Crescendo-Decrescendo systolic murmur

Question 25

What is the treatment for HOCM?

Answer 25

Beta blocker and maintain hydration

Question 26

What often causes MVP?

Answer 26

Congenital -- seen in young women

Question 27

What will be heard with MVP?

Answer 27

Holosystolic murmur = Mid-systolic click

Question 28

What is the treatment for MVP?

Answer 28

Beta blocker and maintain hydration

Question 29

With Dilated Cardiomyopathy, the chambers of the heart will be dilated with thin walls. What are some possible etiologies?

Answer 29

Virus Alcohol Ischemia

Question 30

What often causes Concentric Hypertrophy?

Answer 30

Hypertension

Question 31

What are 3 possible causes of Restrictive Cardiomyopathy?

Answer 31

1. Amyloid 2. Sarcoid 3. Hemachromatosis

Question 32

What are 3 possible causes of Restrictive Cardiomyopathy?

Answer 32

1. Amyloid 2. Sarcoid 3. Hemachromatosis

Question 33

If Amyloid is causing Restrictive Cardiomyopathy, what else may be present? How do you begin to diagnose?

Answer 33

- Peripheral Neuropathy ==> Fat pad/gingival biopsy

Question 34

If Sarcoid is causing Restrictive Cardiomyopathy, what else may be present? How do you begin to diagnose?

Answer 34

- Lung disease ==> Cardiac MRI with endomyocardial biopsy

Question 35

If Hemachromatosis is causing Restrictive Cardiomyopathy, what else may be present? How do you begin to diagnose?

Answer 35

- Bronze DM or Cirrhosis ==> Ferritin level and genetic screen

Question 36

HOCM and MVP will improve with what maneuvers?

Answer 36

More blood in the heart = Leg lift or squat

Question 37

HOCM and MVP will worsen with what maneuvers?

Answer 37

Less blood in the heart = Valsalva

Question 38

With Right sided HF, blood backs up into the IVC/SVC. What are some symptoms?

Answer 38

JVD Hepatosplenomegaly Peripheral edema

Question 39

With Left sided HF, blood backs up into the lungs. What are some symptoms?

Answer 39

Dyspnea on exertion Orthopnea Paroxysmal Nocturnal Dyspnea

Question 40

3 tests to order for evaluation of HF?

Answer 40

- BNP - Echo - Left heart cath

Question 41

3 tests to order for evaluation of HF?

Answer 41

- BNP - Echo - Left heart cath

Question 42

What is the initial treatment for HF? (2)

Answer 42

Beta blocker ACEi

Question 43

What is the initial treatment for HF? (2)

Answer 43

Beta Blocker ACEi

Question 44

Following Beta blocker and ACEi, what can be added to treat HF?

Answer 44

Loop Diuretic

Question 45

Following Beta blocker, ACEi, Diuretic, what can be added to treat HF?

Answer 45

Spironolactone or Isosorbide-Hydralazine

Question 46

Last medication to add for late HF?

Answer 46

Inotrope -- ex. Dobutamine

Question 47

For a HF exacerbation, what is the pneumonic for treatment?

Answer 47

LMNOP = Lasix, Morphine, Nitrate, Oxygen, Position

Question 48

Treatment for HF exacerbation?

Answer 48

LMNOP = Lasix, Morphine, Nitrate, Oxygen, Position

Question 49

With a Systolic dysfunction, what causes it? Expected EF?

Answer 49

LV is thin/atrophied and unable to contract ** EF = < 50% (LOW)

Question 50

With a Diastolic dysfunction, what causes it? Expected EF?

Answer 50

LV is hypertrophied and unable to relax and fill ** EF = > 50% (Normal/HIGH)