Heart Murmurs

Front 1

Mitral stenosis-murmur

Back 1

Mid-Diastolic apical rumble c opening snap.

May have Rv lift 2/2 RVH

Front 2

Mitral Stenosis-si/sx

Back 2

Dec. flow across MV leads to LAE and RVH, pts develop a-fib
Due to rheum. fever

Dyspnea, orthopnea

Front 3

MItral Stenosis-rx

Back 3

B-blocker to slow HR
Lasix 40 mg to dec pulm edema
*Don't give positive inotropic agents

Front 4

Mitral Valve Prolapse

Back 4

Late Systolic murmur c midsystolic click

If symptomatic Atenolol 25mg qd

Front 5

Mitral Regurg-murmur

Back 5

High pitched apical blowing holosystolic murmur that radiates to axilla

Laterally placed PMI, systolic thrill

Front 6

Mitral regurg

Back 6

Often 2/2 inferior wall MI.
Pulmonary edema, dyspnea, a-fib

Front 7

Aortic Regurg-murmur

Back 7

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

Front 8

Aortic Regug-PE

Back 8

Wide pulse pressure
Double peaked atrial pulse
Laterally displaced PMI
-cc:dyspnea

Front 9

Tricuspid Regurg

Back 9

Diastolic rumble confused with MS but increased with resp.

Front 10

Aortic Stenosis-murmur

Back 10

Midsystolic crescendo-decrescendo murmur at 2nd rt space.
Radiates to carotids & apex

Front 11

Aotic Stenosis

Back 11

Classic Triad: Syncope, angina, exertional dyspnea

* Don't give B-blocker or anti-hypertensive

Front 12

Flow Murmurs

Back 12

Short systolic murmurs, 1-2/6,loudest at USB, do not radiate to the neck, asymptomatic

Front 13

Diastolic Murmur
1.
2.

Back 13

Always pathological
1. Aortic Regurg
2. Mitral Stenosis

Front 14

How can I differentiate between diastolic murmurs of AR and MS?

Back 14

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

Front 15

What are the key causes of diastolic murmurs?

Back 15

1. Aortic regurgitation
2. Mitral stenosis

Front 16

How do I differentiate between the systolic murmurs of AS and MR?

Back 16

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

Front 17

Aortic regurgitation (AR) can occur with:

1.
2.
3.
4.
5.

Back 17

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

Front 18

How do the clinical presentations of the systolic murmur conditions differ?

Back 18

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

Front 19

What are common causes of systolic murmurs?

Back 19

1. Flow murmurs
2. Aortic Stenosis (AS)
3. Mitral regurgitation (MR)
4. Hypertrophic cardiomyopathy

Front 20

How do I differentiate between the systolic murmurs of AS and MR?

Back 20

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

Front 21

Aortic regurgitation (AR) can occur with:

1.
2.
3.
4.
5.

Back 21

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

Front 22

What are common causes of systolic murmurs?

Back 22

1. Flow murmurs
2. Aortic Stenosis (AS)
3. Mitral regurgitation (MR)
4. Hypertrophic cardiomyopathy

Front 23

Mitral Regurg-RX

Back 23

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

Front 24

Aortic Regurg-Rx

Back 24

Treat pulmonary edema
Add Nitroprusside & Dobutamine as needed
*Ask about phen-fen use