Paine Podcast murmurs Flashcards by Bethany Eaton

Aortic Stenosis Causes

1) Congenitally abnormal valve (bicuspid)
2) Calcific disease –> most common in US
3) Rheumatic valve disease –> most common world wide

How well did you know this?

Not at all

Perfectly

AS triad sx

1) Dyspnea on exertion
2) Exertional dizziness or syncope
3) Angina

How well did you know this?

Not at all

Perfectly

AS description

+ high pitched, crescendo-decrescendo (diamond shaped) midsystolic murmur

+ soft s2

+s4 may be present

+ often with a loud thrill

How well did you know this?

Not at all

Perfectly

AS auscultation point

2cd R ICS

How well did you know this?

Not at all

Perfectly

AS special notes

radiates to carotid arteries

How well did you know this?

Not at all

Perfectly

AR causes

1) aortic root dilation (retrgrades tears it up)
2) congenital bicuspid valve
3) calcific dz
4) rheumatic heart dz (most common world wide)

How well did you know this?

Not at all

Perfectly

What does AR result in?

volume overloading due to the retrograde flow into the left ventricle

How well did you know this?

Not at all

Perfectly

signs and sx of AR

+ exertional angina and dyspnea

+ sx of HF: PND, orthopnea, pulmonary edema, lower extremity edema

+crackles (rales)

+laterally and inferiorly displaced pMI with a thrill

How well did you know this?

Not at all

Perfectly

description of AR

+ soft, high-pitched, early diastolic decrescendo murmur

+soft S1 with soft/absent s2

+S3 may be present depending on degree of heart failure

How well did you know this?

Not at all

Perfectly

best auscultaion position for AR

L 3rd ICS (erbs)

How well did you know this?

Not at all

Perfectly

speical note for AR

accentuated by pt sitting up and leaning forward at end expiration

How well did you know this?

Not at all

Perfectly

mitral stenosis top causes

1) Rheumatic heart dz
2) mitral annular calcification
3) radiation associated-valve disease (Hodgkin’s lymphoma)

How well did you know this?

Not at all

Perfectly

MS signs and sx

+exertional dyspnea
+decreased exercise tolerance
+hemoptysis (increased pulmonary pressure)
+angina
+fatigue
+ atrial fibrillation (elevated left artial pressure)S2

How well did you know this?

Not at all

Perfectly

MS description

opening snap w/ low pitched diastolic murmur

+decrescendo after S2

+late, diastolic, crescendo before S1

+ loud S1

How well did you know this?

Not at all

Perfectly

MS best auscultation positions

cardiac apex at left 5th intercostal space, midclavicular line

How well did you know this?

Not at all

Perfectly

MS pitch and quality

low pitch, best heard with bell

How well did you know this?

Not at all

Perfectly

special notes for MS

best heard w/ pt in left lateral decubitus in held expiration

How well did you know this?

Not at all

Perfectly

MR causes

1) primary:
+degenerative mitral valve dz (most common in US)- mitral valve prolaps
+Rheumatic Heart dz

2) Secondary
+CAD (regional wall motion abnormality)

+dilated CMP
+Hypertrophic CMP

How well did you know this?

Not at all

Perfectly

sx of MR

exertional dyspnea

fatigue
+afib
+heart failure

How well did you know this?

Not at all

Perfectly

MR description

high-pitched “blowing”, holosystolic murmur

+diminished S1

How well did you know this?

Not at all

Perfectly

MR best auscultation point

+cardica apex at left 5th intercostal space, midclavicular line

How well did you know this?

Not at all

Perfectly

special notes for MR

+radiates to axilla
+no variability in respiration

+decreases in intensity with valsalva

How well did you know this?

Not at all

Perfectly

MVP causes

1) primary
+sporadic (myxomatous degenerations)
+familial (autosomal dominant with incomplete penetrations: 30-50% in first degree releative)

2) secondary
+ connective tissue disorders
+infective endocarditis
+CAD

How well did you know this?

Not at all

Perfectly

signs and sx of MVP

\+palpitations
\+dyspnea
\+exercise intolerance
\+ panic and anxiety disorders
\+ numbness or tingling

How well did you know this?

Not at all

Perfectly

what is myxomatous degenerations

deterioration of connective tissues in certain parts of the body

description of MVP

midsystolic click followed by a uniform, high-pitched, late systolic murmur

best ascultation of MVP

apex

special notes for MVP

responds to dynamic auscultation +increased in sudden standing +decreased in sudden dquating

Tricuspid stenosis causes

1) Rheumatic heart dz 2) atrial myxoma 3) carcinoid syndrome

what is carcinoid syndrome?

The syndrome includes flushing and diarrhea, and less frequently, heart failure, emesis and bronchoconstriction. It is caused by endogenous secretion of mainly serotonin and kallikrein.

s/sx of TS

+abdominal discomfort (hepatic congestion and hepatomegaly) +fluttering sensation in neck caused by JVP +JVD, ascites, peripheral edema

TS descriptions

soft, high-pitched, mid-diastolic

what is the best asucultation point for TS

4th intercostal space on sternal border

special notes for TS

increased during inspiration, squatiing or leg raise

TR causes

1) functional: dilation of RA and ventricle w/dilation of tricuspid annular leaflet (pulm HTN, Left sided heart failure, left to right shunt 2) valvular - valve damage from pacemaker or ICD - Infective endocarditis - rheumatic heart dz - ischemic heart dz

S/sx of TR

- majority are asxymptomatic | - Right sided heart failure: hepatomegaly, hepatic congestion, ascities, heptic venous hum, JVd,edema

description of TR

high-pitched, holosystolic murmur

best auscultation position for TR

4th LLSB,

where does TR radiate to?

right sternum, xiphoid

what can be done to hear TR better?

increased with inspiration, leg raises, or squatting

pulmonic stenosis causes

1) congenital (10% of children w/ congenital heart dz): TOF, noonan syndrome 2) bicuspid valves 3) calcification

s/sx of PS

- exertional dyspnea | - right heart failure

description of Ps

-midsystolic, high-pitched, crescendo-decrescendo - pulmonary ejection click - extends through the A2 - split S2

best auscultation point for PS

2-3rd LICS

special notes for PS

-increased during inspirations

Pulmonic regurg causes

1) primary: iatrogenic, infectious, rheumatic, congenital 2) pulmonary artery hypertension and or dilation 3) physiologic

PR s/s

asx until right ventricular dysfxn occures - exertional dyspnea, fatigue - tacyarrythmias

description of PR

soft, high-pitched, early diastolic decrescendo -graham-steele murmur (pulmonary HTN): high-pitched, blowing with accentuated P2

best ausculatation point for PR

left 2 ICS

what can be done to help one hear PR?

increased with inspirations

what causes an S3

large amonut of blood hitting an very compliant LV (systolic heart failure) best heart at apex +ventricular gallop

S3 decription

Ken----tuck-y occures after S2

S4 cuases

Blood striking a non-compliant left ventricle | Diastolic heart failure, LVH

S4 description

Ten-nes----see apex , late diastolic murmu

what will you hear at the tricuspic area? (4-5 LICS)

Pansystolic: Tricuspid R, VSD mid-to late diastolic: TS, ASD

what will you hear at aortic area? (2 RICS)

ejection type murmur: AS, flow murmur

what will you heart at pulmonic area (2 LICS)

ejection type: PS

what will you heart ate left sternal border/ erbs point

AR, PR (late diastolic)

what will you hear at mitral area? (aka apex)

pansystolic: MR mid-to-late diastolic: MS

what are the diastolic murmuers?

AR, PR, MS

what are the systolic murmurs

mr. taps

what are the pansystolic murmurs?

MR, TR

Paine Podcast murmurs Flashcards

(62 cards)