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 Sounds
Cardiology
| Question | Answer |
|---|---|
| Systolic murmurs include: | AS, PS, MR, TR, MVP |
| Diastolic murmurs include: | AR, PR, MS, TS |
| Aortic stenosis | harsh midsystolic crescendo-decrescendo SEM best at RUSB 2nd R ICS, radiates to carotids. |
| AS: changes with squatting vs standing or Valsalva | Louder w/squatting, quieter w/standing or Valsalva; |
| Aortic regurgitation | soft, high pitched decrescendo diastolic blowing murmur, LSB at 2nd-3rd ICS |
| Mitral stenosis murmur | low-pitched, decrescendo, mid-diastolic rumble best at apex in LLD, loud opening snap after S2 |
| Mitral regurgitation | Split S2, S3 gallop; high blowing holosystolic at apex radiating to axilla |
| Mitral valve prolapse (MVP) murmur: | Late systolic murmur at apex, mid-systolic click (louder squatting) |
| Harsh midsystolic crescendo-decrescendo SEM best at RUSB 2nd R ICS, radiates to carotids | Aortic stenosis |
| soft, high pitched decrescendo diastolic blowing murmur, LSB at 2nd-3rd ICS | Aortic regurgitation |
| low-pitched, decrescendo, mid-diastolic rumble best at apex in LLD, loud opening snap after S2 | Mitral stenosis |
| Mid-systolic click | Mitral valve prolapse (MVP) |
| SEM at pulmonic, fixed split S2 | ASD |
| Elderly w/ systolic murmur | Aortic stenosis: due to calcifications (age related) or bicuspid valve (congenital) |
| Diamond shaped, blowing holosystolic murmur, best at RUSB, 2nd interspace; Pulsus parvus et tardus | Aortic stenosis |
| Low pitched, diastolic rumble near apex with opening snap, best in LLD position | Mitral stenosis (ARMS are BAD); echo, balloon or MVR for sxs |
| Systolic ejection murmur heard best at base with radiation to left clavicle | Pulmonary stenosis |
| Female or Post MI, systolic murmur best at apex preceded by click without radiation | Mitral valve prolapse |
| High holosystolic murmur heard best at apex with radiation to left axilla, palpable LV heave at apex | Mitral regurgitation |
| New murmur (often apical systolic) after MI = | Mitral regurgitation (caused by papillary muscle rupture) |
| Murmur & Hx rheumatic heart disease | Mitral stenosis |
| Continuous harsh, machine-like murmur at 2nd ICS = | PDA (wide pulse pressure and loud S2) |
| Cyanotic infant with systolic thrill at LSB, systolic ejection murmur +/- click, and S2: | Tetralogy of Fallot |
| High pitched holosystolic murmur at LSB (L-to-R), may have diastolic murmur of pulmonic regurgitation: | VSD |
| Infant w/ dyspnea, difficulty feeding. Holosystolic murmur at LSB, 3rd ICS. LVH & RVH | VSD |
| Auscultate when pt is squatting: what effect? | Increases aortic stenosis; decreases HCM (increases preload; more blood separates anterior leaflet from septum => quieter murmur) |
| Austin Flint murmur = | mid-diastolic apical murmur when pt leans forward holding breath on expiration (aortic regurgitation) |
| Aortic area = | RIGHT 2nd ICS (aortic stenosis, aortic regurgitation, HCM |
| Pulmonic area = | LEFT 2nd ICS (PDA) |
| Erb's point = | Left 3rd ICS (aortic or pulmonic valve dz |
| Aortic regurgitation is best heard here: | Erb's point |
| Tricuspid area = | LEFT 4th ICS |
| Mitral area = | LEFT 5th ICS (cardiac apex) |
| pulsus paradoxus = | >10mm Hg SBP decline on inspiration; 2/2 pericardial effusion/tamponade, pericarditis, asthma attack, tension PTX, SVC obstruction |
| Valsalva or pt standing, has what effect? | Decreases aortic stenosis murmur. Increases HCM murmur (decreased venous return & preload -> less blood to separate leaflet from enlarged septum: louder murmur). |
| Put pt in LLD to auscultate: | MS at apex, or S3, S4 |
| Auscultate w/pt sitting, holding breath in expiration and leaning forward: | Aortic regurgitation at LSB |
| HCM auscultation: | Loud S4 at LSB; murmur similar to aortic stenosis, at LSB & apex |
| Graham Steell murmur = | high pitched decrescendo diastolic murmur at LSB = miral stenosis +/- severe pHTN. Heard in mitral stenosis & pulmonic regurg (2/2 pHTN) |
| Pulmonic stenosis murmur = | Harsh midsystolic crescendo-decrescendo SEM at LUSB & radiates to back/neck; inc with inspiration; wide split S2. Longer murmur = more severe dz |
| Pulmonic regurg (2/2 CHD) murmur = | Lower-pitched Graham Steell-type murmur; late diastolic at 3rd-4th left ICS; RV heave |
| Tricuspid stenosis murmur = | Low mid-diastolic / presystolic rumbling at 4th & 5th ICS, LSB, or below xiphoid; Carvallo sign |
| Carvallo sign = | murmur intensified by inspiration (eg, TS) |
| Murmur of ASD: | fixed wide split S2; early: systolic flow murmur at left 2nd-3rd ICS & SEM at pulmonic valve; later: low diastolic murmur at LUSB |
| Murmur in a patent ductus arteriosus: | L to R shunt: continuous precordial murmur (machinery), thrill; R to L shunt: diastolic Graham Steell murmur |
| Tricuspid regurgitation murmur = | high pitched pansystolic murmur (4th ICS in parasternal region); increases on inspiration & decreases on expiration & standing/Valsalva |
| Murmurs radiate in the direction of: | blood flow |
| Inspiration causes: | increased venous return to right ventricle; decreased venous return to left ventricle & reduced LV volume |
| Expiration allows which cardiac vessels to re-expand? | pulmonary vessels & aorta |
| Which murmurs are accentuated by inspiration & expiration? | Inspiration: accentuate Right heart murmurs. Expiration: accentuate Left heart murmurs. |
| Squatting (increasing preload) intensifies all murmurs EXCEPT: | HCM & MVP (but squatting makes MVP click accentuated & earlier) |
| Handgrip increases systemic arterial pressure / HR and increases which murmurs (3)? | MS, MR, AR, MVP. Decreases AS and HCM |
| Drug that mimics the effect of standing / Valsalva: | amyl nitrate |
| Murmur in coarctation of aorta | Ejection murmur at aortic area & LSB, radiates into left axilla & left back |
| VSD murmur: | High pitched holosystolic murmur at LSB (L-to-R); small defects have diamond shaped murmur; may have diastolic murmur of pulmonic regurgitation |
| 80% of patients with this condition have A-fib and diastolic opening snap of S1 | Mitral stenosis |
| Murmur that may cause cardiac dilatation, weakened cardiac muscles, pulmonary HTN due to increased blood flow: | VSD (>ASD) |
| Aortic murmurs: pulse pressures | AS: narrow pulse pressure. AR: wide pulse pressure |
| Auscultate this murmur with bell | Mitral stenosis |
| MS vs TS: louder with expiration or squatting? | MS louder with expiration or squatting; TS quieter with expiration |
| MR louder with: | squatting or in LLD |
| MVP increases with: | standing /Valsalva or handgrip (increased afterload) |
Created by:
Abarnard
Popular Medical sets