Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Heart part 2 murmurs
Advanced Physical Assessment
| Question | Answer |
|---|---|
| Systole | MT close (S1) and then AP open |
| Diastole | AP close (S2) and then MT open |
| Aortic stenosis happens when | systole b/c you use the aortic valve during systole- no blood flow during diastole |
| Which one of the valves closes first? | aortic closes 1st/last to open then pulmonic (mitral 1st to close last to open/t) |
| Mitral and tricuspid fill the ventricles so they are | diastolic |
| Aortic and pulmonic move blood during | systole |
| Regurgitation with mitral valve happens when | systole because this is when it’s supposed to be closed |
| Closure of the valve is | noisy and creates the heart sound- systole |
| systolic murmurs are | aortic stenosis or mitral valve (mr ass) |
| Isovolumetric phase | when all the valves are stopped/red |
| During inhalation | more blood on rt side of the heart |
| During exhalation | more blood on the left side of the heart |
| The more you fill the heart with blood | sounds and murmurs get louder |
| Diastole | AP close/ MT open- mitral valve narrow- diastolic murmur or aortic regurgitation because it’s supposed to be closed= diastole |
| S1 is | systole MT close |
| S2 is the start of | diastole AP close- louder at the base |
| S3 is only heard in | healthy children and prego any others = HF |
| Those with heart failure who have s3 | increase Lasix, pulmonary congestion |
| All innocent murmurs are | systolic |
| Aortic murmurs | can be heard all over the place- not just the base (2/3rd ICS) – apex is the 5th ICS |
| Base means | 2nd and 3rd ICS- aortic murmurs can be heard there but all over the chest |
| What is important with murmurs | when*and where |
| S1 is heard the loudest at | the apex s2 is better at the base |
| S1 you can hear it sometimes | higher than normal- mild mitral stenosis- cannot even hear the murmur |
| Splitting S2 | the right side gets filled with inspiration- the pulmonic will have more work to do and closes late because there’s too much pressure- heard on inspiration- longer and louder |
| Test ?- Wide split- abnormalities of S2 | any condition that increases the pressure or volume on the right side of the heart- pulmonary htn- pulmonic condition happens later and aortic happens earlier so it widens the split. |
| Test ?- fixed splitting of s2 | A fixed split S2 always indicates an atrial septal defect (ASD). A fixed split S2 occurs when there is always a delay in the closure of the pulmonic valve |
| Higher pressure | higher sound |
| Pulmonary htn | abnormal S2 1) 2nd heart sound is loud 2) 2nd heart sound is widely split because the pulmonic component occurs late- loud P2- valve closes late- higher pressure |
| S3 and S4 diastolic heart sounds | heard with the bell- also mitral stenosis murmur- low pitched sounds |
| S3- | low pitched, use your bell, best heard at the apex, in left lateral- one of 2 conditions to turn pt to the left |
| In those over 40 years, S3 is usually pathologic and indicative of | LV failure- S3 has very high specificity but low sensitivity for LV failure- give lasix |
| S3 has high_____ but low_________ | specificity, sensitivity you can say pt has chf if s3 is present, but if not present, you cannot exclude chf |
| Gallop3 | word for s3 – HF- ORDER LASIX |
| In tachycardia | diastole gets shortened- |
| Test question- left ventricular gallop S3 | left sided so it’s softer during inspiration because we put more blood on the right side- ask pt to exhale to hear better |
| Aortic ejection click | clicks during systole because that’s when it opens and it’s stiff- mitral stenosis is early diastole because that’s when it opens |
| MVP click/mitral valve prolapse | leaflets loose when there’s less blood in the heart- blood goes back the other way- the jacket is big when you lose wt- mid systole (closes)- high pitch |
| Opening snap | Mitral stenosis- early diastole because it’s still- click |
| An S1 or S2 caused by a mechanical valve | (following MVR or AVR respectively), will acoustically sound similar to a click- An absent mechanical valve click =valve dysfunction |
| What’s the difference between murmur and bruit? | nothing- it’s outside the heart |
| Abnormal viscosity | anemia- decreased blood viscosity- Increased velocity of blood flow through normal structures- usually systolic |
| Abnormal velocity | hyperdynamic states- sepsis, hyperthyroid- Increased velocity of blood flow through normal structures |
| Abnormal valve | valvular stenosis- decreased diameter of a valve- Decreased diameter of a valve, or vessel- mitral you will hear the murmur during diastole (filling→still going this direction), aortic you will hear during systole as iit’s leaving ventricle |
| Abnormal direction | regurgitation-Flow through an abnormal orifice-valvular regurgitation, VSD left to right shunt- not cyanotic- , PDA patent ductus arteriosus (this happens during systole- valves don’t close- MR) |
| VSD/ventricular septal defect is | a hole between the left ventricles- blood goes left (red blood) to right (blue blood)- get cyanotic when the blue gets to the left- too late for the pt→ NOT CYANOTIC |
| Timing | systolic or diastolic- all innocent murmurs are systole- |
| Diastolic examples | Aortic (most common)/ Pulmonic regurgitation, Mitral/ Tricuspid stenosis (goes forward during diastole) |
| Systolic examples | Flow/innocent murmurs (anemia, hyperdynamic states), Aortic/ Pulmonic stenosis, Mitral/ Tricuspid regurgitation, Ventricular Septal Defect/VSP, Hypertrophic Obstructive Cardiomyopathy, HOCM |
| Combined murmur example | PDA |
| What if you have a valve that is so stenosed that it doesn’t close tightly | aortic regurgitation (diastolic murmur) and stenosis (systolic murmur)- sounds continuous but it’s 2 murmurs in the cycle |
| PDA | continuous murmur- machine-like |
| AS murmur radiate to the | carotid arteries→ radiation |
| MR murmur radiates to the | axilla→ radiation |
| Test question- Decrescendo | usually diastolic murmurs as AR & mild MS- loud S1, opening snap- use bell- turn to the side- prego |
| Crescendo-Decrescendo | usually systolic murmurs as AS |
| Uniform | (aka: “holosystolic”when it occurs in systole): usually the systolic murmur of MR |
| Once you feel the intensity | 4/6- grade 4 |
| Grade 1- 6 | barely audible- experience needed, grade 6 is audible w/o stethoscope- grade 4- feel the thrill |
| MS quality | rumbling |
| MR quality | musical blowing |
| AR quality | blowing |
| AS quality | harsh |
| PDA quality | machine-like |
| More blood in the heart | louder murmur EXCEPTIONS are MVP & HOCM where more blood in the heart decreases murmurs, and less blood in the heart increases their murmurs |
| Atrial stenosis | harsh |
| How to put more blood in the heart/preload | squatting- raising the leg of the pt- except MVP mitral valve prolapse& HOCM |
| Hypertrophic obstructive cardiomyopathy (HOCM) | (decreased murmur intensity) systolic murmur like AS but more blood makes AS more loud but not this one (squatting, leg raise or supine) |
| Hand grip will put more blood in the heart for | MR, AR and VSD- amyl nitrate does the opposite |
| Squatting/Leg raise | increase venous return/preload- thus increase all murmurs except MVP&HOCM- Valsalva and standing do the opposite |
| Valsalva/Standing | decrease venous return/preload- thus decrease all murmurs except MVP&HOCM |
| A pt flailing/knodding his head about is a sign of | AR |
| Possible Test question- Hand grip | increases the resistance/afterload- for regurgitations-will make it louder- goes in an abnormal direction- mitral regurgitation if louder, otherwise aortic stenosis |
| You hear a systolic murmur over the apex- what are 2 conditions | MR ASS Mitral regurg and atrial stenosis- ask pt to squeeze his hand |
| Venous hum | innocent murmur- obliterate the jugular vein to silence – systolic- |
| Stills murmur | innocent murmur- systolic- put over- IJV- Mid systolic murmur |
| Abnormal S1- | mild MS- turn to the left- ask for an echo- LOUD S1 |
| Cardiac valve lesions | SOB- get echo |
| Abnormal S2 | loud in p HTN, massive PE, ASD (fixed split) |
| Abnormal s1 | a-fib |
| Diastole abnormal sounds | S3 and opening snap (mild MS or severe MS) |
| Abnormal systolic click | MVP, aortic ejection click |
| MVP and HOCP | the 2 where if you put more blood in the heart, the sounds are decreased |
| Mitral regurgitation caused by | htn, ischemia |
| Pericarditis | treat with nsaids- pr interval depression on ecg- ST segment elevation in the majority of leads |
| Marfan tall woman | loose connective tissue- decrescendo- blowing- AR- lean forward and make a fist |
| 75 y/o woman with dyspnea and exertional chest pain for several months w/continuous murmur heard well at the apex | combined AS and AR- heard all over the place |
| Tetralogy of Fallot | PS- central cyanosis- fingers, toes, tongue, squatting, parasternal heave, A cyanotic congenital heart defect with 4 abnormalities- Stenotic pulmonary valve-Ventricular septal defect- Overriding aortic valve-Hypertrophy of right ventricle |
| sharp stabbing chest pain is NOT | angina |
| sign for heart attack | levinne’s |
| Scratchy- Sharp, stabbing chest pain. in back, neck or left shoulder-worse w/coughing, swallowing, deep breathing, lying flat, or moving- relieved by sitting up and leaning forward- Difficulty breathing when lying down, a dry cough, anxiety, fatigue | pericarditis- give NSAIDS/ASA- all leads elevated ST and PR interval depression |
| Ventricular Septal Defect in child | systolic- recurrent respiratory infections- If left untreated, the Lt to Rt shunt turns into Rt to Lt one and the patient becomes cyanotic (Eisenmenger syndrome) |
| Vitals: BP 88/56, radial pulse rate 116, Apical pulse rate: HR counted at the apex 140- irregular rhythm | A-fib- synchronized cardioversion (only v-fib not synchronized) |
| young female with chest pain/palpitations | mitral valve prolapse |
| heart failure + aortic stenosis= | the end |
| Acute rheumatic fever | Aimless jerky movements Sydenham chorea- pharyngitis hx- carditis, polyarthritis, chorea, erythema marginatum- rash, sc nodules |
| Blood flow for infants | RA to the LA via the foramen ovale; the RV pumps blood through the DA (closes in 24-48h) into the aorta rather than into the lungs. The foramen ovale then later closes w/pressure |
| 80 y/o man with recurrent syncope | less blood to the brain- aortic stenosis- harsh- crescendo/decrescendo- blowing- listen to the carotid |
| CHF | weight increased, increased venous distention, Lungs bibasilar crackles, dyspnea, uses 3 pillows, edema, S3 (may or may not be there) |
| Cor pulmonale | rt heart failure and hypertrophy secondary to lung dz (COPD)- light headed, syncope |
| h/o chest pressure. Sub-sternal, radiates into left neck. Diaphoresis, nausea | Acute coronary syndrome- most common physical finding for MI is nothing story/EKG/ and enzymes |
| a-fib | synchronized cardioversion except for v-fib |
| 25 yo female with chest pain | mitral valve prolapse |
| Pt with aortic stenosis with chf is | done |
| HOCM s/s | SOB |
| Holosystolic murmur best heard | systolic murmur at the apex which radiates to the AXILLA- |
| SYSTOLIC MURMUR WHICH RADIATES TO THE AXILLA | MRASS MR, if he wants you to say aortic, he would chose the carotid |
| Early diastolic decrescendo, LLSB/apex, Corrigan pulse: bounding carotid pulse (water-hammer), DeMusset’s sign:head “bob” w/beat, Traube’s sign: pistol-shot pulse, Duoroziez’s sign: bruit when the femoral artery compressed, Quincke’s pulses-nails | AR |
| Hoarseness of voice (aka: Ortner’s syndrome): the dilated left atrium will press on the left recurrent laryngeal nerve resulting in hoarseness is seen in | Mitral stenosis |
| Young male athlete | HOCM |
| Aortic regurgitation | diastolic, Corrigan pulse, traube’s sign, quincke’s sign, … |
| Intermittent claudication | PAD- arteries in legs are clogged |
Created by:
arsho453
Popular Nursing sets