Flashcards in Primer 11- Diastolic Murmers Deck (18):
Identify the drug category associated with each the following endings:
3. local anesthetics
5. protease inhibitors
How does hemicholinium inhibit the transport of choline to the nerve terminal?
Hemicholinium --> INHIBITS Na+/choline cotransport into cell
Identify the derivatives of each of the following aortic arches:
3rd--> common carotid artery
Lt 4th--> Aortic Arch
Rt 4th--> proximal rt. subclavian
6th--> proximal pulmonary aa's, ductus arteriosis
List the 4 heart sounds that are BENIGN when there is no evidence of disease processes:
1. Split S1
2. Split S2 on inspiration (pulm valve closes later)
3. S3 in patient UNDER 40yoa
4. Early, quiet, systolic murmur
What will you think of when you have a patient OVER 40 with an S3 murmur?
Heart failure post MI, ischemic heart disease
During diastole, which heart valves are closed and which are open?
Which murmurs might be heard in these valves?
Closed: aortic, pulm--> STENOSIS @ DIASTOLE
Open: tricuspid, mitral--> REGURG @ DIASTOLE
3 important points to take into account when you get a question about a heart murmur:
1. clinical scenario
2. Location (APTM)
3. Systole/ Diastole?
Describe what happens in the thorax during inspiration.
Which two murmurs will get LOUDER with inspiration?
Inspiration--> DECREASE Intrathoracic pressure--> ^ IVC return to RA
1. LOUDER TRICUSPID murmurs (rIght = Inspire)
2. LOUDER SPLIT S2 ( *vs mitral stenosis*)
Describe what happens in the thorax during expiration.
Which murmur will get LOUDER with expiration?
Expiration--> ^ Intrathoracic pressure
1. LOUDER MITRAL murmur (LEft = Expire)
Describe what happens physiologically to the heart with hand grip.
Which murmur gets LOUDER with hand grip?
Grip hands--> ^ SVR --> ^ Afterload
1. LOUDER MITRAL REGURG
Describe what happens in the thorax with the valsalva maneuver.
Which murmur gets LOUDER with this maneuver?
Valsalva--> ^ Intrathroacic pressure--> ^ Preload + ^Afterload
1. MOST murmurs get SOFTER
2. LOUDER HYPERTROPHIC CARDIOMYOPATHY MURMUR
Which murmurs are louder in the lateral decubitus position?
1. Mitral murmurs (stenosis + regrug)
2. LEFT S3, S4
3 causes of aortic regurgitation murmur:
1. dilated aortic root (syphilis, Marfan)
2. bicuspid aortic valve
3. rheumatic fever
When is aortic regurgitation murmur heard?
Where is it loudest?
3 associated clinical findings?
Immediately after S2 in diastole
Loudest @ Lt sternal boarder
1. Wide use pressure (Decrease systemic diastolic pressure)
2. Strong peripheral pulse (water hammer)
3. Head bobbing
What is one common cause of mitral stenosis?
Rheumatic heart disease
What is one clinical outcome of prolonged mitral stenosis?
Left atrial dilation
When is mitral stenosis murmur heard?
Where is it loudest?
Pause between S2 and start of murmur
- Listen for "opening snap"
Loudest @ APEX in lateral decubitus position
Louder with EXPIRATION