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Flashcards in Murmurs Deck (25)
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1

S1

•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

S2

•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

turbulent flow

•increased flow rate --> increased CO

•narrowing ---> increased flow

-valve stenosis

-valve regurgitation

-other (VSD, HCM, PDA)

4

5

Grading a Murmur

6

systolic murmurs

•closing of tricsupid and mitral valves

1) crescendo-decrescendo

-aortic stenosis

-pulmonic stenosis

-hypertrophic cardiac myopathy

2) holosysolic

-mitral regurgitation

-tricuspid regurgitation

-VSD

7

•systolic - crescendo decrescendo

•aortic stenosis

-pulmonic stenosis

-hypertrophic cardiac myopathy

8

•systolic - holosystolic

•mitral regeurgitation

•tricuspid regurgitation

•VSD

9

diastolic murmurs

•closing of aorta and pulmonic valves

•decrescendo

-aortic regurgitation

-pulmonic regurgitation

•rumble 

-mitral stenosis

-tricuspid stenosis

10

•diastolic - decrescendo

•aortic regirgitation

•pulmonic regurgitation

 

11

•diastolic - rumble

•mitral stenosis

•tricsupid stenosis

12

aortic stenosis

•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

mitral regurgitation

•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

aortic regurgitation

•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

mitral stenosis

•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

inspiration

• Increase right-sided murmurs

• Decrease left-sided murmurs (see exceptions below)

17

expiration

• Decrease right-sided murmurs

• Increase left-sided murmurs (see exceptions below)

18

Increase Preload—Leg Raise (increase venous return)

• Increase most murmurs

• Except decrease HCM

19

 Decrease Preload—Standing, Valsalva (decrease venous return)

bear down, increase pressure in chest

• Decrease most murmurs

• Except increase HCM

20

Increase afterload (handgrip/phenylephrine)

• 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

Decrease afterload (vasodilator—amyl nitrate)

•decrease backward flow

• decrease MR and VSD

• increase AS and MS

• increase HCM

22

continuous murmur

•patent ductus arteriosus

23

S3

•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

S4

•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

S2 splitting

•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