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Cardiology – Awesome
Murmurs, heart sounds, pulses
| Question | Answer |
|---|---|
| late peaking systolic murmur | aortic stenosis |
| systolic murmur radiating to carotids | aortic stenosis |
| crescendo-decresendo | aortic stenosis |
| delayed upstroke | aortic stenosis |
| small pulse amplitude throughout entire cardiac cycle | aortic stenosis - there is a fixed obstruction |
| slow rising pulse | aortic stenosis |
| midsystolic decrease in the pulse | HOCM (increased LV out-tract obstruction so less flow leaving in once there is decreased volume in the LV) |
| secondary increase in pulse | HOCM |
| early systolic murmur | HOCM |
| pulsus bisferiens | HOCM |
| Bifid pulse | HOCM - referring to the decrease and then increase in pulse once the outflow tract enlarges again when volume builds up |
| Is there radiation to the carotids in HOCM? | No |
| rapid upstroke, increased pulse pressure | Ao insuff |
| rapid upstroke, nl pulse pressure | MR, HOCM |
| One beat normal, next beat abnormal | pulsus alternans in severe heart failure, tamponade |
| an oscillation of ventilation between apnea and hyperpnea with a crescendo-diminuendo pattern | Cheyne Stokes breathing, severe heart failure, apnea leading to increased CO2 which causes excessive compensatory hyperventilation, in turn causing decreased CO2 which causes apnea, restarting the cycle |
| pulse decreases on inspiration so that you can't feel the pulse | pulsus paradoxus (it's just an exaggeration of the normal response) - SBP decreases greater than 10 points on inspiration, you can hear heartbeat but can't feel the pulse. Increased RV filling, bulging of intraventricular septum, decreased CO |
| what diseases should you think about in pulsus paradoxus? | Tamponade, SVC obstruction, COPD, PE |
| Kussmaul's sign | increase in JVP on inspiration; happens in tamponade, Tricuspid stenosis, etc; trying to pull blood volume into R heart, but something wrong with R heart |
| decreased BP, increase HR, increased JVP, clear lungs | Think R heart problem, Tamponade, SVC obstruction, COPD, PE |
| Auscultation of R 2nd intercostal space | Ao area - Ao stenosis, Ao insufficiency; this is the R base of the heart |
| Auscultation of L 2nd intercostal space | Pulmonic area - Pulm stenosis, Pulm insufficiency, Ao insuff, ASD |
| L 3rd intercostal space | PDA |
| L lower sternal border | Tricuspid area - tricuspid stenosis / ASD, tridcuspid regurg / pulm HTN, ASD |
| pansystolic murmur radiating to the apex | Mitral regurg |
| pansystolic murmur radiating to the L parasternal border | tricuspid regurg |
| machinery murmur | PDA |
| murmur that is pan systolic AND pan diastolic | PDA |
| opening snap and rumble | mitral stenosis |
| diastolic murmur | Ao insuff, Pulm insuff, Mitral stenosis, Tricuspid stenosis |
| bounding pulses | Ao insuff |
| high pitched blowing diastolic murmur | Pulmonic insuff |
| Austin Flint murmur | Ao insuff |
| Apex murmurs | Mitral area; Mitral stenosis, Mitral insuff, also can hear Ao insuff |
| palpation of the L parasternal area | RV |
| Hyperdynamic impulse in L parasternal area | increased RV volume - ASD, tricuspid insuff, VSD |
| Sustained L parasternal heave | RV hypertrophy - mitral stenosis, Pulm HTN, pulm stenosis |
| Hyperdynamic impulse in the apical area | increased LV volume - hyperthyroid, anemia, mitral insuff, Ao insuff with nl EF, PDA, VSD |
| Sustained lift / impulse at Apex | LV hypertrophy - HTN, dilated cardiomyopathy, ischemic heart disease, Ao insuff with low EF |
| Bifid or trifid apical impulse | HOCM with early systolic murmur |
| pansystolic / holosystolic murmurs - 3 | Atrial valves - MR, TR; VSD |
| systolic murmurs - 4 | MR, TR, PulStenosis, AoStenosis |
| diastolic murmurs | AI, PI, Mitral Stenosis, Tricuspid stenosis |
| midsystolic murmur | ventricular valves having to push against the outflow tracts - Pulm Stenosis, Ao Stenosis; usually crescendo-decrescendo |
| midsystolic CLICK | MVP |
| Late systolic CLICK | bicuspid Ao valve |
| friction rub heard with sitting up or leaning forward | pericarditis |
| knock in early diastole | constrictive pericarditis |
| late systolic murmur | MVP |
| mid-diastolic murmur | flow leaving the LA - mitral stenosis; flow leaving the RA - tricuspid stenosis |
| how to tell the difference between ASD and Tricuspid stenosis murmur? | tricuspid stenosis increases on inspiration since increased flow to the R heart; ASD is a constant murmur |
| late-diastolic murmur | atrial myxoma - hits the mitral opening in mid-diastole, and then murmur after that |
| diastolic plop | atrial myxoma when it hits the mitral opening in the middle of diastole |
| early diastolic murmur | AI, PI |
Created by:
christinapham
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