Heart Chpt 14 Seidel Part 2

Front 1

Heart Murmur: Begins with S1, decrescendos, ends well before S2

Back 1

Early systolic

Front 2

Heart Murmur:Begins after S1, ends before S2. crescendo-decrescendo quality sometimes difficult to discern

Back 2

Midsystolic (ejection)

Front 3

Heart Murmur:Begins mid to late systole, crescendos, ends at S2; often introduced by mid to late systolic clicks

Back 3

Late systolic

Front 4

Heart Murmur:Begins with S2

Back 4

Early diastolic

Front 5

Heart Murmur:Begins at clear interval after S2

Back 5

Mid diastolic

Front 6

Heart Murmur: Begins immediately before S1

Back 6

Late diastolic (presystolic)

Front 7

Heart Murmur: Begins with S1, occupies all of systole, ends at S2

Back 7

Holosystolic (pansystolic)

Front 8

Heart Murmur: Begins with S2, occupies all of diastole, ends at S1

Back 8

Holodiastolic (pandiastolic)

Front 9

Heart Murmur: Starts in systole, continues without interruption through S2, into all or part of diastole; does not necessarily persist throughout entire cardiac cycle

Back 9

Continuous

Front 10

Heart Murmur: Barely audible in quiet room

Back 10

Grade I

Front 11

Heart Murmur: Quiet but clearly audible

Back 11

Grade II

Front 12

Heart Murmur: Moderately loud

Back 12

Grade III

Front 13

Heart Murmur: Loud, associated with thrill

Back 13

Grade IV

Front 14

Heart Murmur: Very loud, thrill easily palpable

Back 14

Grade V

Front 15

Heart Murmur: Very loud, audible with stethoscope not in contact with chest, thrill palpable and visible

Back 15

Grade VI

Front 16

Heart Murmur: Increasing intensity caused by increased blood velocity

Back 16

Crescendo

Front 17

Heart Murmur: Decreasing intensity caused by decreased blood velocity

Back 17

Decrescendo

Front 18

Heart Murmur: Constant intensity

Back 18

Square or plateau

Front 19

Heart Murmur: Area of greatest intensity, usually area to which valve sounds are normally transmitted

Back 19

Anatomic landmarks (e.g., second left intercostal space on sternal border)

Front 20

Heart Murmur: Site farthest from location of greatest intensity at which sound is still heard; sound usually transmitted in direction of blood flow

Back 20

Anatomic landmarks (e.g., to axilla or carotid arteries)

Front 21

Heart Murmur: Venous return increases on inspiration and decreases on expiration

Back 21

Intensity, quality, and timing may vary

Front 22

Heart Murmur: Quality depends on several factors, including degree of valve compromise, force of contractions, blood volume

Back 22

Harsh, raspy, machine-like, vibratory, musical, blowing

Front 23

What is a benign murmur?

Back 23

result of a structural anomaly that is not severe enough to cause a clinical problem.

Front 24

Effect on Intensity: Right-sided chambers with Inspiration

Back 24

Increase

Front 25

Effect on Intensity: Right-sided chambers with Expiration

Back 25

Decrease

Front 26

Effect on Intensity: Hypertrophic cardiomyopathy with Valsalva

Back 26

Increase

Front 27

Effect on Intensity: Hypertrophic cardiomyopathy with Squatting to standing (rapidly for 30 seconds)

Back 27

Increase

Front 28

Effect on Intensity: Hypertrophic cardiomyopathy with Standing to squatting (rapidly)

Back 28

Decrease

Front 29

Effect on Intensity: Hypertrophic cardiomyopathy with Passive leg elevation to 45 degrees, patient supine

Back 29

Decrease

Front 30

Effect on Intensity: Mitral regurgitation with Handgrip

Back 30

Increase

Front 31

Effect on Intensity: Ventricular septal defect with Transient arterial occlusion (sphygmomanometer placed on each of patient's upper arms and simultaneously inflated to 20 to 40 mm Hg above patient's previously recorded blood pressures; intensity noted after 20 seconds)

Back 31

Increase

Front 32

Effect on Intensity: Ventricular septal defect with Inhalation of amyl nitrate

Back 32

Decrease

Front 33

Effect on Intensity: ____ with No maneuver distinguishes this murmur. the diagnosis can be made by exclusion

Back 33

Aortic stenosis

Front 34

A heart rate that is irregular but occurs in a repeated pattern may indicate ___

Back 34

sinus dysrhythmia

Front 35

a cyclic variation of the heart rate characterized by an increasing rate on inspiration and decreasing rate on expiration

Back 35

sinus dysrhythmia

Front 36

A patternless, unpredictable, irregular rhythm may indicate heart disease or ___.

Back 36

conduction system impairment

Front 37

Infants with ________ have large, firm livers with the inferior edge as much as 5 to 6 cm below the right costal margin

Back 37

right-sided congestive heart failure

Front 38

In Newborns, A purplish plethora is associated with ___

Back 38

polycythemia

Front 39

In Newborns, shy white color indicates ___

Back 39

shock

Front 40

In Newborns, central cyanosis (i.e., cyanosis of the skin and mucous membranes of the face and upper body) suggests ___

Back 40

congenital heart disease

Front 41

cyanosis of the hands and feet without central cyanosis

Back 41

Acrocyanosis

Front 42

Acrocyanosis in an infant will ___

Back 42

usually disappears within a few days, or even a few hours, after birth

Front 43

Severe cyanosis evident at birth or shortly thereafter suggests___, __, __, __ or __

Back 43

transposition of the great vessels, tetralogy of Fallot, tricuspid atresia, a severe septal defect, or severe pulmonic stenosis

Front 44

Cyanosis that does not appear until after the neonatal period suggests a pure ___, ___, ___ or ___.

Back 44

pulmonic stenosis, Eisenmenger complex, tetralogy of Fallot, or large septal defects

Front 45

The apical impulse in the newborn is usually seen and felt at the ___ intercostal space just medial to the midclavicular line

Back 45

fourth to fifth left

Front 46

In Babies, A ___ shifts the apical impulse away from the area of the ___

Back 46

pneumothorax, pneumothorax

Front 47

In Babies, A ___, more commonly found on the left, shifts the heart to the right.

Back 47

diaphragmatic hernia

Front 48

In Babies, ___ results in an apical impulse on the right

Back 48

Dextrocardia

Front 49

The___ventricle is relatively more vigorous than the ___ in a well, full-term newborn

Back 49

right , left

Front 50

If the baby is thin, you might even be able to feel the closure of the pulmonary valve in the ___ intercostal space.

Back 50

second left

Front 51

Heart Sound __ in infants is somewhat higher in pitch and more discrete than __

Back 51

S2, S1

Front 52

Murmurs are relatively common in the newborn until about ___ of age

Back 52

48 hours

Front 53

When are murmurs a concern for newborns? Describe the length, and duration and sounds

Back 53

murmur persists beyond the second or third day of life, is intense, fills systole, occupies diastole to any extent, or radiates widely

Front 54

In Babies, If you push up on the liver, thereby increasing right atrial pressure, the murmur of a ___ through a septal opening or patent ductus will disappear briefly, whereas the murmur of a ___ will intensify.

Back 54

left-to-right shunt, right-to-left shunt

Front 55

In Babies, Murmurs that extend beyond S2 and occupy diastole are said to have a machine-like quality; they may be associated with a ____

Back 55

patent ductus arteriosus

Front 56

Diastolic murmurs, almost always significant, may nevertheless be transient and possibly related to an ___ or a mild, brief, ___.

Back 56

early closing ductus arteriosus, pulmonary insufficiency

Front 57

In Babies, Rates close to 200 beats per minute are not uncommon, but they may also indicate ___.

Back 57

paroxysmal atrial tachycardia

Front 58

Sinus arrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on ___ and slower on ___.

Back 58

inspiration, expiration.

Front 59

Most organic murmurs in infants and children are the result of ___

Back 59

congenital heart disease

Front 60

Ages 3-7, Caused by the vigorous expulsion of blood from the left ventricle into the aorta, it increases in intensity with activity and diminishes when the child is quiet

Back 60

Still murmur

Front 61

In Pregnant women, the apical impulse is upward and more lateral by ___cm

Back 61

1 to 1.5 cm

Front 62

There is more audible splitting of S1 and S2, and S3 may be readily heard after ___of gestation

Back 62

20 weeks

Front 63

___ may be heard over the pulmonic area in 90% of pregnant women. The murmur is intensified during inspiration or expiration but should not be louder than grade II.

Back 63

systolic ejection murmurs

Front 64

In Older Adults, The apical impulse may be harder to find in many persons because of the _______

Back 64

increased anteroposterior diameter of the chest

Front 65

For Older Adults, In obese older adults, the diaphragm is raised and the heart is more ___.

Back 65

transverse.

Front 66

S4 is more common in older adults and may indicate _______

Back 66

decreased left ventricular compliance

Front 67

In Older Adults, Early, soft physiologic murmurs may be heard, caused by __,__, and ___.

Back 67

aortic lengthening, tortuosity, and sclerotic changes

Front 68

Murmur, Heard with bell at apex, patient in left lateral decubitus position

Back 68

MITRAL STENOSIS

Front 69

Which murmur, Heard over aortic area; ejection sound at second right intercostal borde

Back 69

AORTIC STENOSIS

Front 70

Which murmur, Heard at apex and along left sternal border

Back 70

SUBAORTIC STENOSIS

Front 71

Which murmur, Heard over pulmonic area radiating to left and into neck; thrill in second and third left intercostals space

Back 71

PULMONIC STENOSIS

Front 72

Which murmur, Heard with bell over tricuspid area

Back 72

TRICUSPID STENOSIS

Front 73

Which murmur, Heard best at apex; loudest there, transmitted into left axilla

Back 73

MITRAL REGURGITATION

Front 74

Which murmur, Heard at apex and left lower sternal border; easily missed in supine position; also listen with patient upright

Back 74

MITRAL VALVE PROLAPSE

Front 75

Which murmur, Heard with diaphragm, patient sitting and leaning forward;Austin-Flint murmur heard with bell; ejection click heard in second intercostal space

Back 75

AORTIC REGURGITATION

Front 76

Which murmur, Heard at left lower sternum, occasionally radiating a few centimeters to left

Back 76

TRICUSPID REGURGITATION

Front 77

left ventricle increases in mass and becomes displaced ____

Back 77

laterally

Front 78

LVH due to increased resistance to the emptying of blood into the systemic circulation is from what 3 causes

Back 78

with aortic stenosis, volume overload, and systemic hypertension

Front 79

The right ventricle works harder and enlarges with defects of the ___, ___, ___.

Back 79

pulmonary vascular bed, pulmonary hypertension, and left-to-right shunts

Front 80

__ causes a lift along the left sternal border in the third and fourth left intercostal spaces accompanied by occasional systolic retraction at the apex

Back 80

RVH

Front 81

In ____, sinoatrial dysfunction occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart disease; it may also occur idiopathically. The condition causes dysrhythmias with subsequent fainting, transient dizzy spells, light-headedness, seizures, palpitations, and symptoms of angina or congestive heart failure.

Back 81

sick sinus syndrome

Front 82

A bacterial infection of the endothelial layer of the heart and valves should be suspected with prolonged fever, signs of neurologic dysfunctions, and sudden onset of congestive heart failure. With or w/o murmur. Individuals with valvular defects, congenital or acquired, and those who use intravenous drugs are particularly susceptible. Janeway lesions and Osler nodes are characteristic

Back 82

BACTERIAL ENDOCARDITIS

Front 83

____ are small erythematous or hemorrhagic macules appearing on the palms and soles

Back 83

Janeway lesions

Front 84

____ appear on the tips of fingers or toes. They are caused by septic emboli from the infected heart valve

Back 84

Osler nodes

Front 85

____ is a syndrome in which the heart fails to propel blood forward with its usual force, resulting in congestion in the pulmonary or systemic circulation. Decreased cardiac output causes decreased blood flow to the tissues

Back 85

Congestive heart failure (CHF)

Front 86

___ is characterized by a narrow pulse pressure while ____ CHF has a wide pulse pressure

Back 86

Systolic, diastolic

Front 87

___ results from reduction in myocardial tissue after myocardial infarction or as a consequence of atherosclerotic cardiovascular disease (ASCVD)

Back 87

Systolic CHF

Front 88

The ___ form is the result of advanced glycation products which crosslink collagen and thereby create a stiff ventricle that is unable to dilate actively. It occurs in older adults whose tissue is exposed to glucose for a longer period of time and in individuals with diabetes mellitus. Symptoms can develop gradually or suddenly with acute pulmonary edema

Back 88

diastolic CHF

Front 89

Chest pain is the usual initial symptom in acute ___ .The key physical finding is the triphasic friction rub, which comprises ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole. It is best heard just to the left of the sternum in the third and fourth intercostal spaces and is characteristically scratchy, grating, and very easily heard

Back 89

PERICARDITIS

Front 90

An "excessive" accumulation of effused fluids or blood (300mL) between the pericardium and heart results in ___

Back 90

cardiac tamponade

Front 91

constrains cardiac relaxation, impairing access of blood to the right heart and ultimately causing the signs and symptoms of systemic venous congestion: edema, ascites, and dyspnea. A chronically and severely involved pericardium may also scar and constrict, forming in a sense a shell around the heart that limits cardiac filling. In this circumstance, heart sounds are muffled, blood pressure drops, the pulse becomes weakened and rapid, and the paradoxic pulse

Back 91

CARDIAC TAMPONADE

Front 92

3 common causes of CARDIAC TAMPONADE

Back 92

Pericarditis, aortic dissection, and trauma

Front 93

___ is the enlargement of the right ventricle secondary to pulmonary malfunction

Back 93

Cor pulmonale

Front 94

Alterations in the pulmonary circulation lead to pulmonary arterial hypertension, which imposes a mechanical load on right ventricular emptying. Signs include left parasternal systolic lift and a loud S2 exaggerated in the pulmonic region.

Back 94

Cor pulmonale

Front 95

The LDL goal for individuals with a previous myocardial infarction or with diabetes mellitus is now ___mg/dL.

Back 95

70

Front 96

Symptoms commonly include deep substernal or visceral pain that often radiates to the jaw, neck, and left arm, although discomfort may be mild, especially in older adults or patients with diabetes mellitus. Dysrhythmias are common, and S4 is usually present. Heart sounds are typically distant, with a soft, systolic, blowing apical murmur. Pulse may be thready, and blood pressure varies, although hypertension is usual in the early phases. Atherosclerosis and thrombosis are the common underlying causes.

Back 96

MYOCARDIAL INFARCTION

Front 97

Focal or diffuse inflammation of the myocardium can result from infectious agents, toxins, or autoimmune diseases such as amyloidosis. Initial symptoms are typically vague and include fatigue, dyspnea, fever, and palpitations. As the disease process advances, cardiac enlargement, murmurs, gallop rhythms, tachycardia, dysrhythmias, and pulsus alternans develop.

Back 97

MYOCARDITIS

Front 98

Atrial rate far in excess of ventricular rate; heart sounds not necessarily weak

Back 98

ATRIAL (AURICULAR) FLUTTER

Front 99

Regular uniform atrial contractions occur in excess of 200/min, but the ventricular response is limited as a result of physiologic heart block. The conduction system cannot respond to the rapidity of the atrial rate, causing variance from the ventricular rate. The ECG may look like a saw-tooth cog.

Back 99

ATRIAL (AURICULAR) FLUTTER

Front 100

Slow rate, sometimes below 50 or 60/min. There is no disruption in conduction; not necessarily suggestive of a problem

Back 100

SINUS BRADYCARDIA

Front 101

Dysrhythmic contraction of the atria gives way to rapid series of irregular spasms of the muscle wall; no discernible regularity in rhythm or pattern

Back 101

ATRIAL FIBRILLATION

Front 102

The conduction system is malfunctioning and is in an anarchic state. Any contraction of the atria that gets through to the ventricle is irregular. The sounds are best described as irregularly irregular.

Back 102

ATRIAL FIBRILLATION

Front 103

Heart rate slower than expected, often 25-45/min at rest

Back 103

HEART BLOCK

Front 104

Conduction from atria to ventricles partially or completely disrupted. If conduction is completely disrupted, the ventricle may be left to beat on its own and the heart rate slows considerably

Back 104

HEART BLOCK

Front 105

Rapid, regular heart rate (200/min) without disruption of the rhythm; may be heard only on occasion (in paroxysms) and without loss of vigor in heart sounds

Back 105

ATRIAL TACHYCARDIA

Front 106

This is the result of electrical stimulus originating in a focus in the atrium separate from the SA node. Conduction through to the ventricle is usually complete. Often there is no other evidence of disease, and the patient is usually a young adult. The rate will occasionally decrease with vagal stimulation, holding a deep breath, or gentle massage of a carotid sinus

Back 106

ATRIAL TACHYCARDIA

Front 107

Rapid, relatively regular heartbeat (often nearly 200/min) without loss in apparent strength. The electrical source of the beat is in an unusual focus somewhere in the ventricles. This usually arises in serious heart disease and is a grave prognostic sign.

Back 107

VENTRICULAR TACHYCARDIA

Front 108

Complete loss of regular heart rhythm with expected conduction pattern absent; if weakened and rapid, ventricular contraction is irregular

Back 108

VENTRICULAR FIBRILLATION

Front 109

ventricular septal defect, pulmonic stenosis, dextroposition of the aorta, and right ventricular hypertrophy

Back 109

TETRALOGY OF FALLOT

Front 110

Infants with ____ often have paroxysmal dyspnea with loss of consciousness and central cyanosis; older children develop clubbing of fingers and toes. There is a parasternal heave and precordial prominence. A systolic ejection murmur is heard over the third intercostal space, sometimes radiating to the left side of the neck. A single S2 is heard

Back 110

tetralogy of Fallot

Front 111

The arterial pulse is small, and the jugular venous pulse is unaffected. Regurgitation occurs through the septal defect; as a result, the murmur tends to be holosystolic. It is often loud, coarse, high-pitched, and best heard along the left sternal border in the third to fifth intercostal spaces. A distinct lift is often discernible along the left sternal border and the apical area

Back 111

VSD

Front 112

In VSD, A smaller defect causes a __ murmur and a ___ thrill than a large one

Back 112

louder, more easily felt

Front 113

difference between a VSD murmur and a subaortic stenosis murmur

Back 113

VSD murmur does NOT radiate to the neck

Front 114

A small shunt can be asymptomatic; a larger one causes dyspnea on exertion. The neck vessels are dilated and pulsate, and the pulse pressure is wide. A harsh, loud, continuous murmur is often heard at the first to third intercostal spaces and the lower sternal border. It has a machine-like quality. This murmur is usually, but not always, unaltered by postural change, quite unlike the murmur of a venous hum.

Back 114

PATENT DUCTUS ARTERIOSUS

Front 115

Systolic ejection murmur that is diamond shaped, often loud, high in pitch, and harsh. It is heard best over the pulmonic area and not over the lesion, and may be accompanied by a brief, rumbling, early diastolic murmur. It does not usually radiate beyond the precordium. A systolic thrill may be felt over the area of the murmur, along with a palpable parasternal thrust. S2 may be split fairly widely. palpable thrill on back

Back 115

ATRIAL SEPTAL DEFECT

Front 116

substernal pressure of myocardial ischemia may be felt to the right of the precordium and may more often radiate into the right arm rather than to the left.

Back 116

DEXTROCARDIA AND SITUS INVERSUS

Front 117

a right thoracic heart with normally placed stomach and liver should suggest congenital abnormalities such as ___, ___, ___

Back 117

pulmonic stenosis, ventricular or atrial septal defects, and transposition of the great vessels

Front 118

murmurs of mitral regurgitation and aortic insufficiency; cardiomegaly; the friction rub of pericarditis; congestive heart failure; a migratory polyarthritis (most commonly in the larger joints); chorea (at times without other manifestations); a transient erythema marginatum (pink margins with pale centers); and, rarely in recent years, firm, painless subcutaneous nodules, particularly on, but not limited to, the elbows, knees, and wrists

Back 118

ACUTE RHEUMATIC FEVER

Front 119

Carditis, Polyarthritis, Chorea, Erythema marginatum, Subcutaneous nodules

Back 119

Major Manifestations for Rheumatic Fever

Front 120

___, a condition caused by deposition of cholesterol, other lipids, and by a complex inflammatory process, leads to vascular wall thickening and ultimate narrowing of the vascular lumen. It may cause myocardial insufficiency, angina pectoris, dysrhythmias, and congestive heart failure.

Back 120

Atherosclerotic heart disease

Front 121

____ is usually silent and painless until it produces sudden heart failure, stroke, or dysrhythmias. It also occurs after infarction involving the mitral chordae, along with tachycardia, pallor, a variety of alterations in the heart sounds, occasional pericardial friction rub, various murmurs, and dysrhythmias.

Back 121

Mitral insufficiency

Front 122

With reference to the heart, it indicates a substernal pain or intense pressure radiating at times to the neck; jaws; and the arms, particularly the left. It is often accompanied by shortness of breath, fatigue, diaphoresis, faintness, and syncope

Back 122

ANGINA

Front 123

Amyloid deposits in the heart cause heart failure. Amyloid is itself a fibrillary protein produced by chronic inflammation or neoplastic disease. Electrocardiography or echocardiography shows a small, thickened left ventricle, and the right ventricle may also be thickened. The contractility of the heart may at times be reduced.

Back 123

SENILE CARDIAC AMYLOIDOSIS

Front 124

Older adults, and even some persons of middle age, may develop thickening and calcification of the aortic valves. The result need not be a significant obstruction to left ventricular outflow, but regardless of severity, there may be a midsystolic (ejection) murmur.

Back 124

AORTIC SCLEROSIS

Front 125

substernal pain or intense pressure radiating to neck, jaw, arms

Back 125

Angina

Front 126

reservoirs for blood returning to heart

Back 126

Atria

Front 127

enlargement of right ventricle secondary to pulmonary malfunction

Back 127

Cor pulmonale

Front 128

phase of cardiac cycle where ventricles dilate

Back 128

Diastole

Front 129

congenital syndrome that is characterized by cyanosis after neonatal period

Back 129

Fallot

Front 130

myocardial necrosis secondary to abrupt decrease in coronary blood flow

Back 130

Infarction

Front 131

type of electrical conduction system that makes the heart autonomous

Back 131

Intrinsic

Front 132

middle layer of the heart, responsible for pumping action

Back 132

Myocardium

Front 133

double-walled, fibrous sac encasing the heart

Back 133

Pericardium

Front 134

separates right ventricle from pulmonary artery

Back 134

Pulmonic valve

Front 135

where apical pulse is most readily seen or felt

Back 135

PMI

Front 136

fibers of the ventricular myocardium that conduct the electrical impulses in the heart

Back 136

purkinje

Front 137

backward flow of blood

Back 137

Regurgitation

Front 138

occuring after streptococcal pharyngitis or skin infection. A systemic connective tissue disease

Back 138

Rheumatic fever

Front 139

partition dividing left and right heart chambers

Back 139

septum

Front 140

where impulse of stimulation originates

Back 140

SA node

Front 141

murmur occurring in healthy children 3-7 years of age

Back 141

Still murmur

Front 142

contraction phase of cardiac cycle

Back 142

Systole

Front 143

fine, palpable, rushing vibration

Back 143

Thrill

Front 144

Bacterial infection of the endothelial layer of the heart

Back 144

Endocarditis

Front 145

Syndrome in which the heart fails to propel blood forward

Back 145

CHF

Front 146

Inflammation of the pericardium

Back 146

PERICARDITIS

Front 147

SA node dysfunction

Back 147

sick sinus syndrome

Front 148

Elevated serum cholesterol

Back 148

Hyperlipidemia

Front 149

Opening between left and right ventricles

Back 149

Ventricular septal defect

Front 150

Systemic connective tissue disease that occurs after streptococcal infection

Back 150

ACUTE RHEUMATIC FEVER

Front 151

Substernal pain or intense pressure

Back 151

ANGINA

Front 152

Thickening an calcification of the aortic valve

Back 152

AORTIC STENOSIS

Front 153

Which murmur Narrowed valve restricts forward flow; forceful ejection into ventricle
Often occurs with mitral regurgitation
Caused by rheumatic fever or cardiac infection

Back 153

MITRAL STENOSIS

Front 154

Which murmur, Calcification of valve cusps restricts forward flow; forceful ejection from ventricle into systemic circulation

Back 154

AORTIC STENOSIS

Front 155

Which murmur, Caused by congenital bicuspid (rather than the usual tricuspid) valve, rheumatic heart disease, atherosclerosis
May be the cause of sudden death, particularly in children and adolescents, either at rest or during exercise; risk apparently related to degree of stenosis

Back 155

AORTIC STENOSIS

Front 156

Which murmur, Fibrous ring, usually 1 to 4 mm below aortic valve; most pronounced on ventricular septal side; may become progressively severe with time; difficult to distinguish from aortic stenosis on clinical grounds alone

Back 156

SUBAORTIC STENOSIS

Front 157

Which murmur, Valve restricts forward flow; forceful ejection from ventricle into pulmonary circulation
Cause is almost always congenital

Back 157

PULMONIC STENOSIS

Front 158

Which murmur, Calcification of valve cusps restricts forward flow; forceful ejection into ventricles
Usually seen with mitral stenosis, rarely occurs alone
Caused by rheumatic heart disease, congenital defect, endocardial fibroelastosis, right atrial myxoma

Back 158

TRICUSPID STENOSIS

Front 159

Which murmur, Valve incompetence allows backflow from ventricle to atrium
Caused by rheumatic fever, myocardial infarction, myxoma, rupture of chordae

Back 159

MITRAL REGURGITATION

Front 160

Which murmur, Valve is competent early in systole but prolapses into atrium later in systole; may become progressively severe, resulting in a holosystolic murmur; often concurrent with pectus excavatum

Back 160

MITRAL VALVE PROLAPSE

Front 161

Which murmur, Valve incompetence allows backflow from aorta to ventricle
Caused by rheumatic heart disease, endocarditis, aortic diseases (Marfan syndrome, medial necrosis), syphilis, ankylosing spondylitis, dissection, cardiac trauma

Back 161

AORTIC REGURGITATION

Front 162

Which murmur, Valve incompetence allows backflow from pulmonary artery to ventricle
Secondary to pulmonary hypertension or bacterial endocarditis

Back 162

PULMONIC REGURGITATION

Front 163

Which murmur, Valve incompetence allows backflow from ventricle to atrium
Caused by congenital defects, bacterial endocarditis (especially in IV drug abusers), pulmonary hypertension, cardiac trauma

Back 163

TRICUSPID REGURGITATION

Front 164

Cardiac: valve stenosis, Stokes-Adams attacks, other conduction disturbances
Arteriovenous: ""steal"" syndromes
Nervous: psychologic, autonomic, vagal, coughing
Anemia, altered blood (CO)
Drugs, diabetes, alcohol, poisons
Altitude, acute fevers

Back 164

Causes of Syncope: CANADA

Front 165

Increased titer of antistreptolysin antibodies (antistreptolysin O in particular)
Positive throat culture for group A streptococci
Recent scarlet fever

Back 165

Supporting Evidence of Streptococcal Infection