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MSII Practice of Medicine > Unit 4 - Heart Murmurs > Flashcards

Unit 4 - Heart Murmurs Flashcards

1
Q

what is the PMI?

A

point of maximal impulse (apex

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2
Q

what should you be looking for in the patient overall?

A
  • signs of diminished CO
  • signs of heart failure
  • signs of atherosclerotic disease
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3
Q

what are the 5 spots you should listen to? where are they?

A
  1. aortic valve - 2nd right intercostal space at right sternal border
  2. pulmonic valve - 2nd left intercostal space at left sternal border
  3. second pulmonic - 3rd left intercostal space at left sternal border
  4. tricuspid valve - 4th left intercostal at left sternal border (right-sided heart sounds that radiate)
  5. mitral valve - at the apex; 5th intercostal space at midclavicular line
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4
Q

what is the diaphragm VS bell used for?

A

diaphragm = high pitched sounds
bell (lightly applied diaphragm) = low pitched sounds

must listen to all 5 points with both bell and diaphragm

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5
Q

how should you position the patient? what are they most useful for hearing?

A

at least 2 different positions

  • sitting up and leaning slightly forward (best for high-pitched)
  • supine at 30 degrees
  • supine at 0 degrees
  • left lateral decubitus position (best for low-pitched)
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6
Q

what does “lub” represent? where is it loudest?

A

S1; closure of mitral and tricuspid valves

  • marks beginning of systole
  • corresponds to upstroke of carotid pulse
  • heard loudest at apex
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7
Q

what does “dub” represent? where is it loudest?

A

S2; cloure of aortic and pulmonic valves

  • signals end of systole
  • louder at base of heart
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8
Q

what is S3? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?

A

“Kentucky” ventricular gallop; represents early passive diastolic filling of ventricle (heart failure)

  • heard when filling pressure is elevated
  • gallop rhythm heard immediately after S2
  • low pitched sound, thus heard best with bell at apex in left lateral decubitus position
  • may be normally present in children, adolescents, and young adults
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9
Q

what is S4? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?

A

“Tennessee” atrial gallop; represents active atrial filling of ventricle (second phase of ventricular filling)

  • occurs immediately before S1
  • louder than S3; still heard best at apex with bell in left lateral decubitus OR supine position
  • common in LVH and myocardial ischemia; never normal (always stiff and noncompliant)
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10
Q

what heart sound will not be heard in a patient with atrial fibrilation?

A

S4

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11
Q

what is a summation gallop? where is it best heard?

A

has S1, S2, then S3/4 together

-best heard at apex

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12
Q

where is an intense S1 sound best heard?

A

apex

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13
Q

where is a split S1 sound best heard?

A

tricuspid

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14
Q

where is an intense S2 sound best heard?

A

base

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15
Q

where is S2 splitting best heard? (physiologic expiration)

A

base

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16
Q

what are murmurs?

A

distortion of laminar flow through heart

  • primary cause is malfunction of cardiac valve disrupting flow
  • specific conventions for describing murmur and intensity
17
Q

what descriptions should you use when talking about heart sounds?

A
  • timing (systolic VS diastolic, and duration)
  • pitch
  • pattern (crescendo VS descresendo)
  • location
  • radiation
18
Q

what does holosystolic mean?

A

the heart sound is heard throughout cycle

19
Q

what are the different grades of intensity?

A 
I - barely audible
II - quiet, intensity similar to S1/2
III - moderately loud
IV - loud with thrill (can feel murmur off chest)
V - very loud, easily palpable thrill
VI - audible with stethescope off chest
20
Q

what are examples of systolic murmurs? diastolic murmurs?

A

SM: mitral regurgitation and aortic stenosis
DM: aortic regurgitation and mitral stenosis

21
Q

what is mitral regurgitation? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?

A

systolic murmur; early/late/holosystolic depending on chronicity and severity

  • typically a plateau murmur
  • heard best over cardiac apex
  • can radiate to back and clavicle
  • intensity increases with isometric exercise (increasing afterload)
22
Q

what is aortic stenosis? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?

A

mid-systolic murmur (hear S1, but then S2 is quieter)

  • crescendo-descresendo
  • heard best in aortic region
  • radiates to neck
  • intensity decreases with isometric exercise, but increases with squatting (pushes more blood into heart and increase volume)
  • S2 decreases in intensity as A2 component becomes softer; if severe, S2 will disappear
23
Q

what does pulsus parvus and tardus mean? associations?

A

slow and sustained upstroke of arterial pulse (low volume)

-related to aortic stenosis

24
Q

what is aortic regurgitation? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?

A

diastolic murmur best heard along 3rd intercostal space (2nd pulmonic)
-radiates along left sternal border
-early diastolic and decrescendo in nature
0increases with isometric exercise and squatting

25
Q

what are large volume collapsing pulse signs associated with aortic regurgitation?

A

Watson’s pulse = water-hammer

Corrigan’s pulse = rapid upstroke and collapse of carotid

26
Q

what is De Musset’s sign?

A

head nodding with heart beat associated with aortic regurgitation

27
Q

what is Quincke’s sign?

A

pulsation of capillary bed in nail associated with aortic regurgitation

28
Q

what is Muller’s sign?

A

pulsation of uvula associated with aortic regurgitation

29
Q

what is Becker’s sign?

A

pulsation of retinal vessels associated with aortic regurgitation

30
Q

what is Traube’s sign?

A

“pistol shot” systolic sound heard over femoral artery associated with aortic regurgitation

31
Q

what is mitral stenosis? when does it occur? how and where is it best heard? when is it normally present? what does it represent otherwise?

A

diastolic murmur best heard over apex in left lateral position

  • low pitched rumbling murmur
  • S1 tends to be loud
  • mid-diastolic murmur that extends in duration as stenosis worsens
  • murmur increases with isometric exercise
  • can be iatrogenic, from mitral valve prolapse repair (too small a ring)

MSII Practice of Medicine (13 decks)

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