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Flashcards in Phys exam skills: Murmurs Deck (20)
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1

1. Slow rise of the carotid pulse
2. mid to late peak intensity murmur
3. decreased intensity of the 2nd heart sound

dx aortic stenosis

2

1. absence of murmur radiation to the R carotid artery

r/o aortic stenosis

3

Heart murmurs are produced when _____.

turbulent blood flow causes prolonged auditory vibrations of cardiac structures

4

1. max intensity at 2nd R intercostal space
2. radiates to the R carotid artery and R clavicle

typical for aortic stenosis

5

typical findings for aortic stenosis?

1. max intensity at 2nd R intercostal space
2. radiates to the R carotid artery and R clavicle

6

1. max intensity at 5/6th L intercostal space, midclavicular
2. radiates to the L anterior axilla line and L axilla

typical for mitral regurg

7

typical findings for mitral regurg?

1. max intensity at 5/6th L intercostal space, midclavicular
2. radiates to the L anterior axilla line and L axilla

8

1. max intensity at the lower L sternal border
2. radiates to the lower R sternal border, epigastrum, 5th intercostal space- mid L thorax

typical findings for tricuspid regurg

9

typical findings for tricuspid regurg?

1. max intensity at the lower L sternal border
2. radiates to the lower R sternal border, epigastrum, 5th intercostal space- mid L thorax

10

1. max intensity at the 5th L intercostal space, midclavicular
2. radiates to the lower L sternal border

typical for hypertrophic cardiomyopathy

11

typical findings for hypertrophic cardiomyopathy?

1. max intensity at the 5th L intercostal space, midclavicular
2. radiates to the lower L sternal border

12

What is apical-carotid delay? What does it mean?

assess the R carotid pulse and R brachial arterial pulse simultaneously with both hands. Delay btw the 2 = abnormal.

13

What signifies a grade 4 murmur?

a thrill (palpable precordial vibration)

14

How is the 4th heart sound best heard?

using the bell of the stethoscope in the L lateral decubitus position

15

____ are associated with MVP.

Systolic clicks

16

Systolic clicks are associated with ____.

MVP

17

What maneuvers increase the intensity of R sided murmurs? How do they do this?

1. quiet inspiration
2. sustained ab pressure

.... by increasing venous return

18

How are L sided heart murmurs intensified? How do they do this?

place an inflated BP cuff on each arm- murmur should intensify after 20 sec
.... by increasing systemic arterial resistance

19

What maneuvers increase venous return AND systemic arterial resistance?

standing to squatting, passive leg elevation

20

How does the Valsalva maneuver decrease the intensity of aortic stenosis murmurs?

it decreases venous return and increases systemic arterial resistance