Murmurs

Front 1

almost all cases 2/2 rheumatic heart disease

Back 1

mitral stenosis

Front 2

long-standing mitral stenosis leads to what?

Back 2

pulmonary HTN --> RV failure; AFib

Front 3

Murmur: opening snap followed by low-pitched diastolic rumble and presystolic accentuation, followed by loud S1

Back 3

Mitral stenosis

Front 4

long-standing aortic stenosis leads to what?

Back 4

LV dysfunction; LV dilatation may pull MV apart --> mitral regurgitation

Front 5

3 symptoms of aortic stenosis (bad prognosis once they are present)

Back 5

angina, syncope, heart failure

Front 6

Murmur: harsh crescendo-decrescendo systolic murmur, radiates to carotids; S4; parvus et tardus (diminihsed and delayed carotid upstrokes)

Back 6

Aortic stenosis

Front 7

Treatment of mitral stenosis:
1) asymptomatic
2) mild symptoms
3) severe

Back 7

1) nothing
2) diuretics; AFib as needed
3) surgery (percutaneous balloon valvuloplasty is excellent)

Front 8

Treatment of aortic stenosis
1) asymptomatic
2) symptomatic

Back 8

1) nothing
2) aortic valve replacement

Front 9

Causes of aortic regurg:
1) acute
2) chronic

Back 9

1) infective endocarditis, trauma, aortic dissection
2) primary valvular (RhF, bicuspid valve, Marfan's, etc), aortic root disease (syphilitic aortitis, OI, aortic dissection, Behcet's, etc)

Front 10

Murmur: diastolic decrescendo murmur; low-pitched diastolic rumble (Austin-Flint-- relative mitral stenosis); +/- S3, WIDENED PULSE PRESSURE (incr systolic, decr diastolic), corrigan's pulse: rapidly increasing pulse that collapses suddenly as arterial pressure decreases rapidly in late systole and diastole

Back 10

Aortic regurgitation

Front 11

De Musset's sign (AR)

Back 11

head bobbing (rhythmical jerking of head)

Front 12

Muller's sign (AR)

Back 12

uvula bobs

Front 13

Duroziez's sign (AR)

Back 13

pistol-shot sound heard over femoral arteries

Front 14

Treatment of aortic regurgitation:
1) asymptomatic
2) symptomatic or significant LV dysfxn
3) acute

Back 14

1) Na restriction, diuretics, vasodilates, digoxin, ACE inhibitors, restric strenuous activity
2) aortic valve replacement
3) EMERGENT AORTIC VALVE REPLACEMENT

Front 15

Causes of mitral regurgitation
1) acute
2) chronic

Back 15

1) endocarditis, papullar muscle rupture (infarction) or dysfxn (ischemia)
2) RF, Marfan's, CM

Front 16

Murmur: holosystolic at apex, radiates to black or clavicle; AFib; S3 gallop, laterally displaced PMI, loud, palpable P2

Back 16

Mitral Regurgitation

Front 17

Treatment for mitral regurgitation

Back 17

Vasodilators, Na reduction, diuretics, digoxin, antiarrhythmics

Mitral valve repair before LV fxn too severely compromised

Front 18

Causes of tricuspid regurgitation

Back 18

RV dilation (LV failure, RV infarction, inferior wall MI, cor pulmonale)
Tricuspid endocarditis (IVDU)
Epstein's anomaly
Carcinoid syndrome, SLE, myxomatous valve degeneration

Front 19

Murmur: blowing holosystolic murmur incr with inspiration, reduced with expiration or Valsalva; pulsatile liver

Back 19

Triscupid regurgitation

Front 20

Cause of mitral valve prolapse

Back 20

common in pts with genetic connective tissue disorders

Front 21

Treatment of mitral valve prolapse:
1) asymptomatic
2) systolic murmur/thickened valve
3) chest pain

Back 21

1) nothing
2) dental ppx
3) beta-blockers?

Front 22

new murmur + unexplained fever =

Back 22

suspect infective endocarditis

Front 23

Murmur: mild systolic ejection @ pulmonary area, wide/fixed S2, diastolic flow rumble

Back 23

ASD

Front 24

new murmur + unexplained fever =

Back 24

suspect infective endocarditis

Front 25

Murmur: mild systolic ejection @ pulmonary area, wide/fixed S2, diastolic flow rumble

Back 25

ASD

Front 26

Murmur: harsh, blowing holosystolic murmur with thrill @ 4th L intercostal space; decreases with Valsalva and handgrip

Back 26

VSD