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19 Cards in this Set
- Front
- Back
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What murmurs are best heard with the bell? |
Low pitched murmurs, a good example is the third heart sound of mitral stenosis. |
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What causes a physiological split S2 and how common is it. |
The lower pressures in the pulmonary circulation mean that blood can flow into the pulmonary artery even after the end of R vent. systole (don't ask me how, this is what Talley says). Therefore, the aortic valve snaps shut before the pulmonary and produces two separate sounds. It is present in up to 70% of normal adults. However, the pulmonary valve closure is so soft it may only be heard in the pulmonary area. It is widened during inspiration due to increased venous return. |
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What common condition produces a loud S2? |
Systemic HTN |
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A third heart sound; a) occurs in what part of the cardiac cycle b) is best heard at which location c) may be heard in what conditions |
a) during diastole and is thought to be caused by tautening of the mitral or tricuspid pap muscles at the end of rapid diastolic filling b) Apex (in L vent. S3) and Left sternal edge (R vent. S3) c) L - High output states (thyrotoxicosis, pregnancy), Aortic and mitral regurg, ventricular septal defect R - RVF, Constrictive pericarditis |
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A fourth heart sound; a) occurs in what part of the cardiac cycle b) may be heard in what conditions |
a) Late diastole. Caused by the atrial pressure waves reflected back due to a poorly compliant ventricle. Requires an effective atrial contraction. b) L - any condition with poor L vent compliance, AS, acute mitral regurg, HTN, IHD. Often present during MI and may be the only physical sign of that condition. R - Pulmonary HTN or Pulmonary stenosis |
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What is an opening snap? |
High-pitched sound that occurs in mitral stenosis after S2 and indicates opening of the mitral valve. It will then be followed by a diastolic murmur as the flow goes through the mitral valve. |
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What features do you use to describe a murmur? (4) |
- Timing - Area of greatest intensity - loudness and pitch - The effect of dynamic manoeuvres |
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Where is the best place to listen for murmurs caused by HCM? |
5th intercostal space, medial to apex beat. |
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Name 4 causes of pan-systolic murmurs. |
1) Mitral regurg 2) Tricuspid regurg 3) Ventricular septal defect 4) Aortopulmonary shunts |
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Name 2 causes of late-systolic murmurs. |
1) Mitral valve prolapse 2) Papillary muscle dysfunction where the mitral regurg begins in midsystole |
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You hear a murmur but have no hands with which to feel a pulse. What is the best way to distinguish between systolic and diastolic murmurs? |
Diastolic murmurs are usually much softer. Very unlikely to be a diastolic murmur if its loud. |
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What will produce a collapsing pulse and a decrescendo early diastolic murmur? |
Aortic regurg |
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What sound has been likened to the crunching sound of walking on snow? |
Pericardial friction rub |
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True or False. A soft mid-systolic murmur can be ignored because it is unlikely to represent severe AS. |
False. Severe AS may only have soft murmur. |
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Describe the grading system for murmurs. |
1/6 - Very soft. Only gods (and probs Marvs) can hear it. 2/6 - Soft but detectable by the experienced auscultator 3/6 - Moderate but no thrill 4/6 - Loud. Mild thrill palpable 5/6 - Very loud. Thrill easily palpable. 6/6 - Loud +++ dont even need to put steth right on the chest. |
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How might respiration help differentiate which side of the heart a murmur originates? |
Right sided murmurs become worse on inspiration. Left sided murmurs become worse on expiration. |
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The murmur generated by which condition will increase during a valsalva? |
The systolic murmur of HCM |
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Which murmur is always audible in the neck? |
AS |
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Which endocrine pathology may produce carotid bruits in the absence of stenosis? |
The increased vascularity of the thyroid in thyrotoxicosis may lead to a systolic bruit in the carotid arteries. |
