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CRRAB I Final > Murmurs - Johns > Flashcards

Murmurs - Johns Flashcards

1
Q

What is the grade of most murmurs?

A

III

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2
Q

When does diastole occur?

A

After S2

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3
Q

Describe an aortic stenosis murmur:

A
  • Early to mid-systolic
  • Heard best over base and tends to radiate to carotids
  • Crescendo-decresendo
  • Late stages may have decreased systolic pressure and slow carotid upstroke (rather than a tapping pulsation)
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4
Q

What is the etiology of Aortic Stenosis?

A

Degenerative calcific, rheumatic, bicuspid

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5
Q

What is the pathophysiology of aortic stenosis?

A

Pressure gradient over 50 mm or valve area represents critical obstruction (1/3 of normal valve area)

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6
Q

What are the symptoms of Aortic Stenosis?

A

Angina, syncope, dyspnea on exertion

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7
Q

What is the treatment for Aortic Stenosis?

A
  • Valve replacement

- Balloon valvuloplasty in children and young adults

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8
Q

Describe a mitral insufficiency (regurgitation):

A
  • Even, blowing murmur
  • Holosystolic murmur
  • Heard best at apex, tends to radiate to the axilla (putting stethoscope on axilla to hear it)
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9
Q

What is the etiology for Mitral Insufficiency?

A

RHD, congenital, acute MI with papillary muscle dysfunction, endocarditis, calcification with age

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10
Q

What is the pathophysiology of Mitral Insufficiency?

A

Decreased forward flow
Acute - little enlargement of left atrium, pulmonary edema
Chronic - large left atrium

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11
Q

What are the symptoms of Mitral Insufficiency?

A

Acute - pulmonary edema

Chronic - Severe fatigue, atrial fibrillation

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12
Q

What are the treatments of Mitral Insufficiency?

A
  • Medical treatment for CHF, atrial fibrillation

- Surgery: patients with severe MR with limitations of work or routine household tasks

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13
Q

Describe Mitral Stenosis:

A
  • Diastolic murmur best heard at apex with patient in left lateral recumbent position
  • Low pitched (rumble)
  • Opening snap precedes murmur
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14
Q

What is a typical mitral stenosis case?

A

Women from Nigeria, pregnant in 2nd trimester with pulmonary edema - has mitral stenosis

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15
Q

What is the etiology of mitral stenosis?

A

Most are rheumatic, rarely congenital

-Decreased incidence since strep treatment

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16
Q

What is the pathophysiology of mitral stenosis?

A
  • Normal valve orifice is 4-5 cm2, left atrial pressure rises with 2 cm2
  • Pulmonary hypertension
  • Resultant right ventricular failure
17
Q

What symptoms are associated with mitral stenosis?

A
  • Dyspnea with exertion and cough
  • Hemoptysis
  • Arterial embolism
18
Q

What is the treatment for mitral stenosis?

A
  • Antibiotic prophylaxis

- CHF, Atrial fibrillation - Valve replacement if valve area less than 1.0 cm2

19
Q

Describe Aortic Insufficiency (regurgitation):

A

-High pitched diastolic murmur heard best at base of heart

20
Q

When is aortic insufficiency best heard?

A

With patient sitting

  • Louder with inc. severity
  • “water-hammer” pulse, increased pulse pressure
21
Q

What is the etiology of aortic insufficiency?

A

2/3 are rheumatic - Endocarditis, trauma (car accidents), congenital

22
Q

What is the pathophysiology of aortic insufficiency?

A

Increased SV

-Deterioration of left ventricular function precedes symptoms

23
Q

What are the symptoms of aortic insufficiency?

A
  • May be asymptomatic for years
  • Uncomfortable awareness of heartbeat when lying down, exertion dyspnea first symptom followed by orthropnea and PND - Angina, CHF
24
Q

How do you treat aortic insufficiency?

A

Difficult to time: Patients asymptomatic until myocardial dysfunction develops
-Myocardial dysfunction does not return after surgery

25
Q

Describe Mitral Valve Prolapse:

A
  • Click-murmur syndrome
  • Mid or late systolic click
  • May be followed by a high pitched late systolic murmur
  • Heard best at the apex
26
Q

What is the etiology of mitral valve prolapse?

A

Congenital or genetic, very common, females between 14-30

27
Q

What is the pathophysiology of mitral valve prolapse?

A

Myxomatous degeneration of posterior leaflet

-Usually benign but may trigger arrhythmias

28
Q

How do you treat mitral valve prolapse?

A

Reassure

29
Q

What are innocent murmurs?

A
  • Always systolic ejection in nature
  • Occur without evidence of physiologic abnormalities
  • Grade I or II intensity
  • No thrills or radiation
  • End well before S2
  • Found in 30-50% of children
30
Q

What are three right sided murmurs?

A
  1. Tricuspid stenosis
  2. Tricuspid regurgitation
  3. Pulmonic stenosis
31
Q

What is Tricuspid stenosis?

A

Rare in developed countries, rheumatic, associated with mitral stenosis, giant A wave in neck, diastolic murmur best heard along lower left sternal border and xiphoid (right ventricular failure –> most often caused by left sided failure)

32
Q

What is tricuspid regurgitation?

A

Functional from right ventricular dilation, signs of right sided heart failure, holosystolic murmur at LLSB, prominent v waves in neck

33
Q

What is pulmonic stenosis?

A

-Usually preceded by ejection click, mid systolic murmur like this is probably benign.

CRRAB I Final (21 decks)

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