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CV HY Murmurs

Day 7

Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd R interspace close to the sternum. Aortic stenosis
Early diastolic decrescendo murmur best heard along the left side of the sternum. Pulmonic or aortic regurgitation (aortic regurg radiates to apex)
Late diastolic decrescendo murmur heard best along the L side of the sternum. Tricuspid stenosis
Pansystolic (holosystolic or uniform) murmur best heard at the apex and often radiates to the L axilla Mitral regurgitation
Late systolic crescendo murmur usually preceded by a mid-systolic click. Mitral prolapse
Crescendo-decrescendo systolic murmur best heard in the 2nd to 3rd L interspaces close to the sternum Pulmonic stenosis
Pansystolic (holosystolic or uniform) murmur heard best along the L lower sternal border and generally radiates to the R lower sternal border Tricuspid regurgitation or VSD
Rumbling late diastolic murmur with opening snap Mitral stenosis
Pansystolic (holosystolic or uniform) murmur best heard at the left parasternal 4th-6th IC spaces. Tricuspid regurgitation or VSD
Continuous machine-like murmur (in systole and diastole) PDA
High pitched diastolic murmur associated with a widened pulse pressure. Aortic regurgitation
Which murmurs are best heard in the L lateral decubitus position? Mitral regurgitation, mitral stenosis, L-sided S3 and S4 heart sounds
An 80yo presents with a systolic crescendo-decrescendo murmur. What is the most likely cause? Aortic stenosis
Increase in intensity with inspiration (general) R sided heart sounds
Increase in intensity with expiration (general) L sided heart sounds
Which murmurs are heard in systole? Aortic/pulmonic stenosis, mitral/tricuspid regurgitation
Which murmurs are heard in diastole? Aortic/pulmonic regurgitation, mitral/tricuspid stenosis
Name 5 causes of aortic stenosis. 1. Congenital bicuspid valve (>40yo) 2. Senile or degenerative calcifications (>60yo) 3. Chronic rheumatic valve disease 4. Congenital unicuspid aortic valve 5. Syphilis
Which murmurs can be caused by rheumatic fever? Mitral regurg, mitral stenosis, aortic regurg, aortic stenosis, tricuspid regurg
Which murmur is associated with pulsus parvus et tardus (weak pulses compared to heart sounds) and can lead to syncope? Aortic stenosis
A newborn with a holosystolic, harsh-sounding murmur that is loudest at the tricuspid area. VSD
IV drug user with a holosystolic, harsh-sounding murmur that is loudest at the tricuspid area. Tricuspid regurgitation
Which prophylactic antibiotics should be used in patients with mitral prolapse or regurgitation who are having dental procedures? Penicillins (e.g., aminopenicillins) or 1st generation cephalosporins (cefalexin)
Bounding pulses and head bobbing Aortic regurgitation
What can be used to reduce the intensity of aortic regurgitation murmurs? Vasodilators
Which murmur is often due to congenital rubella or prematurity? PDA
What is wide splitting (exaggeration of normal splitting) caused by? Conditions that delay RV emptying: pulmonic stenosis or R bundle branch block
What is fixed splitting caused by? ASD (L-->R shunt increases flow thru pulmonic valve so that, regardless of breath, pulmonic closure is greatly delayed)
What is paradoxical splitting (normal order of valve closure is reversed so aortic closes b/f pulmonic such that audible split disappears on inspiration) caused by? Conditions that delay LV emptying: aortic stenosis, L bundle branch block
Can be caused by RV dilation or endocarditis, esp in IV drug users. Tricuspid regurgitation (endocarditis in IV drug users can damage tricuspid valves)
Crescendo-decrescendo murmur that radiates to the carotids/apex. Aortic stenosis
Excess of what substance causes the floppy, parachute-like valve seen in mitral prolapse? GAG dermatan sulfate
Syncope, angina, dyspnea Aortic stenosis (SAD)
Low-pitched holosystolic murmur at L sternal border that increases with hand grip maneuver VSD
Midsystolic pulmonary ejection murmur at the left sternal border due to increased flow across the pulmonic valve ASD
Dyspnea and orthopnea with bibasilar lung crackles in a patient 6 mos post-MI with a holosystolic murmur over the apex and an S3 gallop. The murmur and gallop disappear after treatment with diuretics and vasodilators. Functional mitral regurgitation (caused by acute L ventricle dilation rather than an actual problem with the valve itself)
What is the major hemodynamic compensation for aortic regurg? Increase in LV preload (to maintain CO) and eccentric (sarcomeres added in series) hypertrophy. Remember eccentric hypertrophy happens w/volume overload and concentric (sarcomeres added in parallel) happens w/pressure overload (HTN, aortic stenosis)
Created by: sarah3148



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