Pathology: Murmurs: Block Ii

Front 1

Normal newborn exam with fixed splitting of S2

Back 1

Atrial Septal Defect

Front 2

Loud precordial or left sided systolic murmur from birth with or without cyanosis.

Back 2

Ventricular Septal Defect - often associated with trisomy 21.

Front 3

Machinery murmur throughout systole and diastole.

Back 3

Patent Ductus Arteriosus

Front 4

Right sided S3 with diastolic murmur at left upper sternal border

Back 4

Pulmonary Insufficiency

Front 5

Low pitched diastolic murmur at the apex, may radiate to the axilla.

Back 5

Mitral Stenosis

Front 6

Systolic murmur at the apex that radiates to the axilla at times

Back 6

Mitral Insufficiency

Front 7

Mid-systolic click sometimes followed by the murmur, increases and moves earlier in systole with valsalva

Back 7

Mitral Valve Prolapse

Front 8

Often harsh systolic murmur that can be associated with S4 if LVH occurs or S3 if dilation of ventricles occurs as a result

Back 8

Aortic Stenosis

Front 9

Blowing diastolic murmur possibly with associated S3 and S4 when severe

Back 9

Aortic Insufficiency

Front 10

Murmur on right upper sternal border that may radiate to neck:

Back 10

Aortic

Front 11

Murmur on left upper sternal border that may radiate to back:

Back 11

Pulmonic

Front 12

Murmur on left lower sternal border that does not usually radiate:

Back 12

Tricuspid

Front 13

Murmur at the apex of the heart that may radiate to the axilla:

Back 13

Mitral

Front 14

What is indicated by a murmur that is left sided and not associated with any other findings in a person under 40?

Back 14

Innocent murmur

Front 15

This occurs when pressure in the inferior vena cava is increased from its normal baseline of 0-7 mmHg.

Back 15

Jugular Venous Distension (JVD)

Front 16

If a pt. has JVD and pulmonary edema, what is the cause?

Back 16

The cause is on the left side of the heart causing backup and congestion all the way through the circuit

Front 17

If a patient has JVD and no pulmonary edema what is the cause?

Back 17

The cause is somewhere between the proximal end of the pulmonary capillary and the inferior vena cava - like isolated right heart failure.

Front 18

Name four possible causes of JVD without pulmonary edema:

Back 18

1. Isolated right heart failure
2. Pulmonary HTN
3. Tricuspid Stenosis
4.Superior Vena Cava Syndrome

Front 19

Name three causes of a widely split S2 that varies with inspiration but doesn't disappear:

Back 19

1. Right Bundle Branch Block
2. Pulmonic Stenosis
3. Early Closure of the Aortic Valve (BAD mitral regurgitation)

Front 20

What is the cause of a fixed split S2? Why does this happen?

Back 20

Atrial Septal Defect- The increased pulmonary blood flow from left to right shunting delays the closure of the pulmonic valve.

Front 21

When P2 occurs before A2 during expiration (splitting of S2 occurs when breathing out):

Back 21

Paradoxical Split

Front 22

What causes a paradoxical split of S2?

Back 22

This can only happen when the aortic valve is delayed in closing so a left bundle branch blockis the most common cause.

Front 23

If an S3 is heard in an adult over 40, what is the general cause?

Back 23

It is caused by the blood entering a ventricle that is already volume and pressure overloaded (like CHF).

Front 24

If an S3 is heard at the apex of the heart, which side is the cause?

Back 24

The left heart (CHF).

Front 25

If an S3 is heard at the lower left sternal border, which side is the cause?

Back 25

Right side of the heart - this is more unusual because it indicates right sided pressure and volume overload

Front 26

This heart sound is heard when blood enters a thickened, stiffened ventricle:

Back 26

S4

Front 27

In which condition would one hear continuous scratchy sound in all phases of the cardiac cycle?

Back 27

Pericarditis.

Front 28

The valsalva maneuver or standing from sitting or squatting have what effect on the heart?

Back 28

It decreases the preload.

Front 29

Which conditions does the valsalva maneuver or standing from sitting or squatting make worse?

Back 29

Hypertrophic obstructive cardiomyopathy and Mitral valve prolapse. These murmurs will increase.

Front 30

What effect do squatting and leg raises have on the heart?

Back 30

It increases preload - increases blood return from the lower body

Front 31

What effect will maneuvers that increase preload (leg raises, squatting) have on heart murmurs? Which ones won't have the same response as the others?

Back 31

This will increase ventricular volumes and will make all left sided heart murmurs louder except MVP and Hypertrophic CM.

Front 32

What effects does a handgrip have on the heart?

Back 32

Increases afterload by increasing upper extermity blood pressure.

Front 33

Which murmurs will get worse with increased afterload (handgrip)? Which ones will get better?

Back 33

Worse: Regurgitant aortic valve, mitral valve regurgitation
Better: HOCM and aortic stenosis

Front 34

This manuver will increase a murmur caused by aortic stenosis but decrease a murmur caused by HOCM:

Back 34

Squatting, leg raise - Increases preload

Front 35

Which manuver would cause decreased murmur of aortic stenosis and increased mumur of hypertrophic obstructive cardiomyopathy (HOCM)?

Back 35

Valsalva or standing from sitting/squatting - decreases preload

Front 36

Which manuver would decrease the murmur of aortic stenosis and HOCM but increase the murmur of aortic and mitral regurgitation?

Back 36

Handgrip - increased afterload

Front 37

What manuver increases right ventricular preload? Which murmurs would be worse?

Back 37

Inspiration - This makes pulmonic stenosis worse and tricuspid regurgitation

Front 38

This refers to a greater than normal decrease in systolic blood pressure with inspiration

Back 38

Pulsus Paradoxus - normal is less than 10 mmHg

Front 39

What are three common caused of pulsus paradoxus?

Back 39

1. Constrictive Pericarditis
2. Cardiac Tamponade - due to pericardial effusion
3. Severely increased intrathoracic pressures (obstructive lung disease)

Front 40

Name three common causes of Hypoxia:

Back 40

1. Right to left shunt
2. Bad pulmonary HTN
3. Pulmonary edema (from L sided heart failure)