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11 Cards in this Set

  • Front
  • Back

Hypertension -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings:


- Elevated BP



2) Additional Findings:


- With TOD: S3, S4 heart sounds; PMI displacement; hypertensive retinopathy



3) Sports Participation:


- W/ all but markedly elevated BP or evidence of TOD, full participation should be encouraged b/c of CV benefit of exercise

Physiologic Murmur (aka Innocent or functional murmur) -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings:


- Grade 1-3/6 early to mid-systolic murmur, heard best at LSB, but usually audible over precordium



2) Additional Findings:


- No radiation beyond precordium


- Softens or disappears w/ standing


- Increases in intensity w/ activity, fever, anemia


-S1, S2 intact, normal PMI



3) Sports Participation:


- Full participation


- Patient should be asymptomatic, w/ no report of chest pain, HF sxs, palpitations, syncope, and activity intolerance

Aortic Stenosis (AS) -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings:


- Grade 1-4/6 harsh systolic murmur, usually crescendo-decrescendo pattern, heard best at 2nd RICS, apex



2) Add'l Findings:


- Radiates to carotids


- May have diminished S2, slow filling carotid pulse, narrow pulse pressure, loud S4


- Softens w/ standing


-The greater the degree of stenosis, the later the peak of murmur



3) Sports Participation:


- Impact in participation varies w/ degree of stenosis -


Mild: Full participation


Moderate: Selected participation


Severe: No participation



- In younger adults, usually congenital bicuspid valve


- In Older adults, usually calcific, rheumatic in nature



-Dizziness and syncope are ominous signs, pointing to severely decreased cardiac output


Mitral Stenosis (MS) -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings:


- Grade 1-3/4 low-pitched late diastolic murmur best heard at the apex, localized


- Short crescendo-decrescendo rumble, similar to a bowling ball rolling down an alley or distant thunder



2) Add'l Findings:


- Often w/ an opening snap, accentuated S1 in the mitral area


-Enhanced by left lateral decubitus position, squat, cough, immediately after valsalva maneuver



3) Sports Participation:


- Impact in participation varies w/ degree of stenosis -


Mild: Full participation


Moderate: Selected participation


Mild w/ atrial fibrillation: Selected particip.


Severe: No participation



-Nearly all cases rheumatic in origin


-Protracted latency period, then gradual decrease in exercise tolerance, leading to rapid downhill course as a result of low cardiac output


-Atrial fibrillation common

Mitral Regurgitation (MR) -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings:


- Grade 1-4/6 high-pitched blowing systolic murmur, often extending beyond S2


- Sounds like "haaa," "hooo"


- Heard best at RLSB



2) Add'l Findings:


- Radiates to the axilla, often w/ laterally displaced PMI


- Decreased w/ standing, Valsalva maneuver


- Increased by squat, hand grip



3) Sports Participation:


- Impact in participation varies w/ ventricular size and function -


*MR w/ normal LV size & function: full part.


*MR w/ mild LV enlargement but normal cardiac function at rest: Selected part.


*MR w/ LV enlargement or any LV dysfunction at rest: No participation



-Origin: Rheumatic, ischemic heart disease, endocarditis


-Often w/ other valve abnormalities (AS, MS, AR)


Aortic Regurgitation (AR) -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings:


- Grade 1-3/4 high-pitched blowing diastolic murmur heard best at 3rd LICS



2) Add'l Findings:


- May be enhanced by forced expiration, leaning forward


- Usually w/ S3, wide pulse pressure, sustained thrusting apical impulse



3) Sports Participation:


- Impact in participation varies w/ ventricular size, function, and dysrhythmias -


*AR w/ normal or mildly increased LV size & function: Full participation


*AR w/ moderate LV enlargement, PVCs at rest and w/ exercise: Selected partic.


*Mild to moderate AR w/ sxs, severe AR, AR w/ progressive LVH: No participation



-More common in men, usually caused by rheumatic heart disease, but occasionally by tertiary syphilis


Mitral Valve Prolapse (MVP) -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings:


- Grade 1-3/6 late systolic crescendo murmur w/ honking quality, heard best at apex


- Murmur follows mid-systolic click



2) Add'l Findings:


- W/ Valsalva maneuver or standing, click moves forward into earlier systole, resulting in longer sounding murmur


- W/ Hand grasp or squat, click moves back further into systole, resulting in a shorter murmur



3) Sports Participation:


- Impact in participation varies w/ ventricular function and dysrhythmia -


*MVP alone: Full participation


*MVP w/ mild to moderate regurgitation, dysrhythmias such as repetitive SVT, complex ventricular dysrhythmias: Selected participation



- Often seen w/ minor thoracic deformities such as pectus excavatum, straight back, and shallow anteroposterior diameter

Hypertrophic Cardiomyopathy (HCM) -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings:


- Harsh mid-systolic crescendo-decrescendo murmur heard best at LLSB or at the apex



2) Add'l Findings:


- Murmur may increase w/ standing, squat, or Valsalva maneuver


- Triple apical impulse, loud S4, bisferiens carotid pulse



3) Sports Participation:


- Dyspnea, chest pain, post-exertional syncope often reported


- Sports participation should be determined on an individual basis according to degree of ventricular function and symptoms

Still Murmur (aka vibratory innocent murmur) -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings


- Grade 1-3/6 early systolic ejection, musical or vibratory, short, often buzzing, heard best midway between apex and LLSB



2) Additional Findings


- Softens or disappears when sitting or standing or w/ Valsalva maneuver


- Usual onset , 2-6 y.o.; may persist through adolescence


- Benign condition



3) Sports Participation


-Benign finding


-No limitation on sports participation

Atrial Septal Defect (ASD), w/o surgical intervention-



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings


- Grade 1-3/6 systolic ejection murmur heard best at ULSB w/ widely split fixed S2



- May be accompanied by a mid-diastolic murmur heard at the 4th ICS LSB common, caused by an increased flow across tricuspid valve



2) Additional Findings


- Twice as common in girls


- Child may be entirely well or present w/ HF


- Often missed in first few months of life or even entire childhood


- Watch for child w/ easy fatigability



3) Sports Participation


- W/ correction, full sports participation is typical


- W/o correction, sports participation should be determined on an individual basis according to degree of pulmonary HTN, right-to-left shunt, and symptoms

Ventricular Septal Defect (VSD), w/o surgical intervention -



1) Important Exam Findings



2) Additional Findings



3) Impact on Sports Participation

1) Important Exam Findings


- Grade 2-5/6 regurgitant systolic murmur heard best at LLSB


-Occasionally holosystolic, usually localized



2) Additional Findings


- Usually w/o cyanosis


- W/ small to moderate-sized left-to-right shunt and w/o pulmonary HTN, likely to have minimal symptoms


- Larger shunts may result in HF w/ onset in infancy



3) Impact on Sports Participation


-W/ Correction, full sports participation is typical


-W/o correction, sports participation should be determined only on an individual basis according to degree of pulmonary HTN, right-to-left shunt, and symptoms