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9 Cards in this Set
- Front
- Back
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Are holosystolic murmurs always pathological? How many things cause them?
Midsystolic ejection murmurs? Both are types of what? What type of murmurs are caused by large pressure gradients? Low pressure gradients? |
3; always pathological.
no. systolic murmurs. High-velocity/High-freq Low V / f |
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Midsystolic ejection murmurs are always related to what? When do they inevitably end?
Are physiological murmurs common? What's the first sound we should assess in general on auscultation? How can you rule out HOCM w/ PE? What can help you assess the innocence/congenital nature of a systolic murmur (AV/PV)? (esp in USA) When might this not actually be as helpful? |
ejection of blood through the ventricular outflow tracts, AV, & PV
*before* the relevant semilunar valve closure sound. yes, especially in the young and fit. May be up to Grade 3. S2, see if it's wide / paradoxical. carotid pulse, apical impulse, and the murmur's response to Valsalva / Squat. check for an ejection click. If it's heard, then think congenital / valvular defect. Once the valve has calcified (long-term degenerative changes) |
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Aortic valve ejection sounds (clicks) are *typically* heard best in what area? What can they be confused with?
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mitral area
S4 |
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The pulmonary ejection click seemingly paradoxically gets louder on ______ and softer on _____. Why?
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expiration, inspiration.
Exaggerated filling of the RV on inspiration --> higher P --> moves the PV out a little --> it doesn't have as far to go when it actually opens --> gets softer. |
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Which is the most common cause of a systolic ejection murmur in kids: valvular, subvalvular, post-valvular?
In which diz would you hear a wide, fixed S2? Why? |
valv --> sub --> post
ASD; the defect removes the selective filling of the RA that occurs w/normal inspiration, and it's wide because the shunt is usually L-->R = fixed & split. |
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Which type of calcified/inflammed aortic valve presents at an earlier age, bicuspid or triscupid?
As the AV gets more calcified in the progression of stenotic dz, what two things change about the murmur? What happens w/ A2 in severe AS? What can be seen/felt on top of the carotid pressure recording in AS? Apical Impulse? What is the palpable equivalent of S4? Can CXR help Dx? |
bi-cuspid presents earlier.
ejection click diminishes and the loudest point of the murmur happens later (both due to calcification) It delays, which can lead to reversed/paradoxical splitting - eventually it won't even make a sound if AS gets bad enough. 'shudder' (turbulent) Same as LVH: exaggerated/sustained 'heaving' of the top of the impulse, it is longer; also A wave A-wave Not too much, just like LVH... you can see a weird bulge of the aorta though, b/c these pts usually have a collagen abnormality. |
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Can EKG help Dx AS? How about Echo?
Can AS pt have Sx of Angina? How important are Sx in AS? Plz put the following in order as prog markers in AS (better prog-->worse): failure, angina, syncope |
EKG will show LVH
Echo will be good b/c you can assess the valve leaflets themselves. Yes. ***Very - let us know when to intervene. - not any test findings angina (5y) --> syncope (3y) --> failure (2y) |
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AV regurg is usually caused by one of two things, what are they?
Major sign on auscultation? Are they acute or chronic? Differences? What is the most common cause of acute aortic regurgitation we see? |
dz of the valve
dz of the root: dilation of the root causes the valve leaflets to be pulled apart *EARLY* Diastolic decrescendo murmur they can be either/or. - acute: pressure will be elevated, w/o dilation b/c there hasn't been time yet. Pulmonary congestion develops because of this pressure backup. - chronic: LV and LA pressures are N to slightly elevated b/c they have dilated to compensate. **eccentric hypertrophy** due to volume overload. Endocarditis |
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What are you aiming for in AV valve replacement for Aortic regurg? Why is it important to identify those who are sub/asymtomatic?
Will a systolic flow murmur appear in AV regurg? why? Can it be the primary finding? What is the key in not letting any pts slip into the tx-won't-help-as-much window? What is mortality post-surgery related to? |
that the dilation of the LV and LA will resolve, somewhat.
If they pass the point of no return, the valve replacement won't allow their ht to recover. Yes, in mid-to-late stage; the increased SV due to the backflow will cause it. Yes, it can be. Keep assessing their left ventricular function. Whether or not their LV function and EJ fraction comes back. |
