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24 Cards in this Set

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Mitral stenosis-murmur
Mid-Diastolic apical rumble c opening snap.

May have Rv lift 2/2 RVH
Mitral Stenosis-si/sx
Dec. flow across MV leads to LAE and RVH, pts develop a-fib
Due to rheum. fever

Dyspnea, orthopnea
MItral Stenosis-rx
B-blocker to slow HR
Lasix 40 mg to dec pulm edema
*Don't give positive inotropic agents
Mitral Valve Prolapse
Late Systolic murmur c midsystolic click

If symptomatic Atenolol 25mg qd
Mitral Regurg-murmur
High pitched apical blowing holosystolic murmur that radiates to axilla

Laterally placed PMI, systolic thrill
Mitral regurg
Often 2/2 inferior wall MI.
Pulmonary edema, dyspnea, a-fib
Aortic Regurg-murmur
3 Murmurs
-Blowing early diastolic at aorta&LSB
-Apical diastolic rumble(Austin Flint. *similar to MS but no opening snap)
-Midsystolic flow murmur at base
Aortic Regug-PE
Wide pulse pressure
Double peaked atrial pulse
Laterally displaced PMI
-cc:dyspnea
Tricuspid Regurg
Diastolic rumble confused with MS but increased with resp.
Aortic Stenosis-murmur
Midsystolic crescendo-decrescendo murmur at 2nd rt space.
Radiates to carotids & apex
Aotic Stenosis
Classic Triad: Syncope, angina, exertional dyspnea

* Don't give B-blocker or anti-hypertensive
Flow Murmurs
Short systolic murmurs, 1-2/6,loudest at USB, do not radiate to the neck, asymptomatic
Diastolic Murmur
1.
2.
Always pathological
1. Aortic Regurg
2. Mitral Stenosis
How can I differentiate between diastolic murmurs of AR and MS?
The early diastolic, high-pitched descrecendo murmur of AR heard maximally in the 2nd Rt ICS with radiation down the LSB. It almost mimics a breath sound. A wide pulse pressure often accompanies a pulse with a rapid rise and fall. Use a diaphragm and have the patient lead forward with his or her breath held.

In contrast, the MS murmur is low-pitched, mid-diastolic, and heard at the apex. A presystolic crescendo is often heard as the atrial kick sends blood across the stenotic mitral valve. Use a lightly placed bell over the apex, or in the axilla, and ask the patient to lie in the left lateral decubitus position to best hear the murmur of MS
What are the key causes of diastolic murmurs?
1. Aortic regurgitation
2. Mitral stenosis
How do I differentiate between the systolic murmurs of AS and MR?
AS is diamond-shaped (crescendo-decrescendo), heard best at the BASE and radiates to the CAROTIDS.

MR is HOLOSYSTOLIC, heard at the APEX and radiates to the AXILLA
Aortic regurgitation (AR) can occur with:

1.
2.
3.
4.
5.
Aortic regurgitation (AR) can occur with:

1. congenital bicuspid valves
2. rheumatic heart disease
3. endocarditis
3. ankylosing spondylitis
4. rheumatoid arthritis
5. aortic root dilatation/dissection: Marfan's syndrome, aortitis (syphilis, vasculitis
How do the clinical presentations of the systolic murmur conditions differ?
AS-older patients and causes syncope and chest pain and dyspnea.

MR-may present acutely if MI(inferior>anterior)causes a rupture papillary muscle.

HCM-young patients with a family history of early cardiac problems Patients may experience few symptoms before a sudden cardiac arrest/event
What are common causes of systolic murmurs?
1. Flow murmurs
2. Aortic Stenosis (AS)
3. Mitral regurgitation (MR)
4. Hypertrophic cardiomyopathy
How do I differentiate between the systolic murmurs of AS and MR?
AS is diamond-shaped (crescendo-decrescendo), heard best at the base and radiates to the carotids.

MR is holosystolic, heard at the apex and radiates to the axilla
Aortic regurgitation (AR) can occur with:

1.
2.
3.
4.
5.
Aortic regurgitation (AR) can occur with:

1. congenital bicuspid valves
2. rheumatic heart disease
3. endocarditis
3. ankylosing spondylitis
4. rheumatoid arthritis
5. aortic root dilatation/dissection: Marfan's syndrome, aortitis (syphilis, vasculitis
What are common causes of systolic murmurs?
1. Flow murmurs
2. Aortic Stenosis (AS)
3. Mitral regurgitation (MR)
4. Hypertrophic cardiomyopathy
Mitral Regurg-RX
Treat pulmonary edema
Nitroprusside to inc. forward flow 5ug/kg/min IV c close monitering
Pts hypotensive c nitroprusside add dobutamine 2.5-20 ug/kg/min
Aortic Regurg-Rx
Treat pulmonary edema
Add Nitroprusside & Dobutamine as needed
*Ask about phen-fen use