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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 |
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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 |
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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
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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 |
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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)
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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
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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 |
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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 |
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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 |
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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 |
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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 |