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Flashcards in Murmurs Deck (25)
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1
Q

S1

A
  • loudest at the apex
  • sound of the tricuspid and mitral valves closing
  • after S1 and before S2 is systole
  • systole begins at #9: when LV pressure exceeds LA pressure
  • systole ends at #17: when aortic and pulmonic valves close
2
Q

S2

A
  • heard loudest at the base
  • sound of pulmonic and aortic valves closing
  • after S2 abd before the next S1 is diastole
  • diastole beins at #17: when aortic and pulmonic valves close
  • diastole ends at #9: when tricuspid and mitral valves close
3
Q

turbulent flow

A
  • increased flow rate –> increased CO
  • narrowing —> increased flow
  • valve stenosis
  • valve regurgitation
  • other (VSD, HCM, PDA)
4
Q
A
5
Q

Grading a Murmur

A
6
Q

systolic murmurs

A

•closing of tricsupid and mitral valves

1) crescendo-decrescendo
- aortic stenosis
- pulmonic stenosis
- hypertrophic cardiac myopathy
2) holosysolic
- mitral regurgitation
- tricuspid regurgitation
- VSD

7
Q
A
  • systolic - crescendo decrescendo
  • aortic stenosis
  • pulmonic stenosis
  • hypertrophic cardiac myopathy
8
Q
A
  • systolic - holosystolic
  • mitral regeurgitation
  • tricuspid regurgitation
  • VSD
9
Q

diastolic murmurs

A
  • closing of aorta and pulmonic valves
  • decrescendo
  • aortic regurgitation
  • pulmonic regurgitation

•rumble

  • mitral stenosis
  • tricuspid stenosis
10
Q
A
  • diastolic - decrescendo
  • aortic regirgitation
  • pulmonic regurgitation
11
Q
A
  • diastolic - rumble
  • mitral stenosis
  • tricsupid stenosis
12
Q

aortic stenosis

A
  • systolic murmur - left side
  • crescendo decrescendo
  • starts when aortic valve opens (#12) , stops when closes (#17)
  • blood having a hard time pushing through
  • syncope, angina, dyspnea
13
Q

mitral regurgitation

A
  • systolic murmur - left side
  • holosystolic
  • begins when mitral valve closes (#9) and ends when mitral valve opens again (#21)
  • starts as soon as systolic pressure is greater than atrial pressure, lasts as long as LV pressure exceeds LA pressure
14
Q

aortic regurgitation

A
  • diastolic murmrur - left side
  • decrescendo
  • starts when aortic valve closes ( #17) and continues until aotic valve opens again (#12)
  • heard better while pateint is sitting up, can cause head bobbing, murmur over femorals
  • during diastole, blood leaks back
  • high pulse pressure (systolic BP goes up a little, diastolic BP goes down)
  • can cause a flow murmur during suystole due to extra blood
15
Q

mitral stenosis

A
  • diastolic - left side
  • rumble
  • blood has a hard time pushing throuh
  • starts when mitral valve opens (#21) and ends when mitral valve closes (#9)
  • can end up causing a fib and pulmonary edema
16
Q

inspiration

A
  • Increase right-sided murmurs
  • Decrease left-sided murmurs (see exceptions below)
17
Q

expiration

A
  • Decrease right-sided murmurs
  • Increase left-sided murmurs (see exceptions below)
18
Q

Increase Preload—Leg Raise (increase venous return)

A
  • Increase most murmurs
  • Except decrease HCM
19
Q

Decrease Preload—Standing, Valsalva (decrease venous return)

bear down, increase pressure in chest

A
  • Decrease most murmurs
  • Except increase HCM
20
Q

Increase afterload (handgrip/phenylephrine)

A
  • Increase backward flow
  • Increase MR and VSD
  • Decrease AS and MS
  • Decrease HCM (more blood in ventricles, increases size of ventricle and opens up outlfow tract)
21
Q

Decrease afterload (vasodilator—amyl nitrate)

A
  • decrease backward flow
  • decrease MR and VSD
  • increase AS and MS
  • increase HCM
22
Q

continuous murmur

A

•patent ductus arteriosus

23
Q

S3

A
  • early in diastole (after S2)
  • hear failure with reduced EF
  • more blood left in LV
  • blood hits blood —> vibration of walls

•chronic mitral regurgitation

  • bllod into atrium, whcih eventually gets back to lV
  • bllod hits blood —> vibration of walls

•children and pregnant women - not pathologic

24
Q

S4

A
  • late in diastole (before S1)
  • contraction of atria pushes extra blood in
  • anyone with stiff heart
  • HTN
  • HFpEF
  • blood hits stiff wall
  • with a fib, no S4 heard
25
Q

S2 splitting

A

•inspiration, physiologic

-negative pressure, more blood comes in and pulmonic valve stays open longer

•wide

  • RV failure (MI)
  • pulmonary hypertension
  • RBBB (late contraction)

•fixed

-atrial septal defect (more blood into right heart)

•paradoxical

  • aortic closes after pulmonic
  • LBBB
  • LV failure