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100 Cards in this Set
- Front
- Back
Systole?
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Contraction of the heart
S1 to S2 |
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Diastole?
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Resting of the heart
S2 to the next S1 |
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S1 represents closure of which valves?
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Mitral and tricuspid valves
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S2 represents closure of which valves?
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Aortic and Pulmonic valves
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Which side of the heart do the valves close first?
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Left side
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Where is theMitral valve?
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Usually the 5 th ICS MCL
can be pushed more over to the left if pt has cardiomegaly |
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Where is the Pulmonic valve?
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2 nd L ICS
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Where is the Tricuspid valve?
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4-5th L ICS
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Where is Erbs point?
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3 rd L ICS
Intesity of S1 should = S2 |
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Where is the Aortic valve?
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2nd Rt ICS
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Where do you listen for mitral regurg or MS?
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At the Apex, not the PMI, because that can be displaced
in the epigartrim with rt heart cardiomegaly Mitral Area= Apex |
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Where is the RA?
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5 cm below the sternal angle
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Where is the RV?
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Under the body of the sternum
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What are the AV valves?
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Mitral and tricuspid
atrioventricular |
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What are the Semilunar valves?
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pulmonic and aortic
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Murmurs are caused by?
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Turbulent bloodflow
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What sound does stenosis make?
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Not opening
Rumbling |
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What sound does regurg make?
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Blowing
Not closing Incompetent |
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Diaphragm?
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High
Press Hard H&H |
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Bell?
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Low
Press lightly If you press hard it will function as a diaphragm L&L |
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Which murmurs are diastolic?
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MS ARD
Mitral Stenosis and Aortic Regurg |
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Which murmurs are systolic?
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MR ASS
Mitral Regurg and Aortic Stenosis |
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Which HS is louder at the base of the heart S1 or S2?
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S2
If S1 is louder at the base of the heart (2nd ICS), it may be from Pulmonary HTN |
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Which HS is louder at the apex of the heart S1 or S2?
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S1
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Which murmurs = pathology?
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Diastolic and Holosystolic Murmurs
Systolic Murmurs are usually benign |
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What is the PMI?
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area on the chest wall where you can best feel the beating of the heart. It is usually just left of the breast
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Which HS are high pitched?
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Listen with diaphragm
S1 & S2 Split S1 Split S2 Murmurs can be low or high pitched sounds |
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Which HS are low pitched?
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Listen with bell
S3 & S4 Murmurs can be high or low pitched sounds |
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Where is the best place to hear a split S2?
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Pulmonic area
2nd Lt ICS |
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Where is the best place to hear a split S1?
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Aortic area
2nd Rt ICS |
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Best place to hear a Split S 1?
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4-5th L ICS
next to the sternum Tricuspid area |
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Fixed Split?
What would you look for when you hear a fixed split? |
Constant split & timing
1-2-2 Pathopneumonic for an atrial septal defect |
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Widely split?
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Stays as 2 different sounds
Splits more on inhalation |
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Paradoxical Split?
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Opposite of physiologic split
HEAR IT ON EXHALATION, disappears on inhalation Present with LBBB Can't diagnose an MI in presence of LBB with just and EKG |
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Physiological Split?
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Pulmonic is best place ot hear S2 split
2nd ICS Lt side, sometimes radiates into the 3 rd IC Audible on INHALATION, not exhalation |
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S3?
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Sloshing in
Kentucky CHF (3 words) late diastole ventricular gallop really is the 3rd heart sound Bell rapid ventricular filling into a dilated ventricle Turn pt to left side first marker for CHF |
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4 types of S2 splits?
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1 Physiological Split
2 Paradoxical Split 3 Widely Split 4 Fixed Split |
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S4?
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A----stiff-wall
Tenessee HTN early diastole Bell Marker for HTN Turn pt to left lateral side Atrial contraction when ventricles resist filling can find in kids =pathology when >40 yrs |
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Opening snap?
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A sharp, high-pitched sound heard in early diastole, associated with the opening of the abnormal valve in cases of mitral stenosis
happens right after S1 usually lt sided |
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Ejection Click?
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associated with high pulmonary resistance and hypertension, they are common and of no clinical significance in pregnant women and in many other healthy people.
if mital valve right after S2 |
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How do you classify a murmur?
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1 Pitch (high/ low)
2 Quality (rumbling/ blowing) 3 Shape (crescendo/ decrescendo) 4 Timing 5 Intensity (grade 1-6 as a fraction) 6 Location 7 Radiation |
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Earliest presenting symptom of AR?
Progressive sympts? |
palpitations.
Progresses from palpitations to DOE, easy fatiguability. Later to LVH, failure and angina at rest. |
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AR occurs most often secondary to?
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1 rheumatic fever
2 2nd to untreated syphilis 3 bacterial endocarditis 4 connective tissue disease (Reiter’s syndrome, anklyosing spondilitis). |
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AR, occurs when aortic valve is supposed to be?
Describe the murmur of AR? |
closed, leads to backflow
and audible diastolic murmur, high pitched, blowing. Best heard with pt sitting up, leaning forward, exhales and holds breath. |
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AR is best heard with pt in what position?
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sitting up, leaning forward, exhales and holds breath.
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AR is loudest in what location?
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aortic area, radiates to 3rd and 4th ICS.
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Long term AR produces?
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loud early diastolic murmur that extends past mid-diastole, with S3, bounding pulse and wide pulse pressure.
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How do you diagnose AR?
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via echo with Doppler
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Management of AR?
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cardiology consult immediately
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What s/s would cause you to consult with cardiology immediately?
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1 evidence worsening dyspnea
2 signs LVH and strain 3 increased cardiomegaly on CXR 4 falling ejection fraction and increased LV end systolic dimension. |
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Meds for AR?
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Often begin dig and HCTZ with onset dyspnea climbing one flight of stairs without evidence LVH.
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S/Sx of MS?
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include DOE, often acute with disease progression
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MS corresponds to?
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increased LA pressure and pulmonary venous congestion
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MS often has a symptom interval of?
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10 years
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MS=?
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narrowing of mitral valve
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MS is what kind of murmur?
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diastolic murmur that doesn’t radiate: only heard at apex
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Which position is best to hear MS in?
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especially in LL decubitus position.
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What may increase murmur intensity?
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Exertion may increase murmur intensity.
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Heard after pause after which HS?
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S2, low pitch, rumbling, maybe with increased intensity S1.
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With MS, which HS may be heard louder at the base of the heart?
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S1 may > S2 at base
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MS may produce a click or a snap?
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maybe with OS (follows S2)
Not Opening |
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MS can be complicated by?
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a fib and preceded by PACs and PAF
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On CXR, MS may present as?
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lateral view,dilation of LA, pulmonary HTN (increased right pulmonary artery, RVH)
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On EKG, MS may present as?
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QRS shift > 60 degrees. With pulmonary artery pressure increase, induces RVH
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Caution with MS with ?
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in pregnancy or with extreme exertion.
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MR's often the result of ?
MR's associated with? |
rheumatic fever, or S/P MI.
MR's associated with MVP (which indicates a need for endocarditis prophylaxis) |
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On Hx, with MR you may find pt has?
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DOE, easy fatiguability.
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S/Sx with MR?
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LVH, displaced PMI, apical pansystolic murmur, S3, mid-diastolic rumble and sometimes wide split S2.
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MR On EKG?
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right and left atrial enlargement
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Diet for MR?
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No added salt diet (2 gm), HCTZ
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Rx for MR?
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valve replacement. Endocarditis prophylaxis.
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AS is what kind of murmur?
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systolic murmur, which occurs as blood passes through a narrowed aortic valve while the ventricles contract.
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AS is loudest in?
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aortic area, often crescendo-decrescendo
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AS can radiate?
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to carotid
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AS is often associated with a click or snap?
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ejection click (opening sound from aortic valve) secondary to calcium deposition on valve
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AS is easier to hear if pt is in what position?
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sits, leans forward and breathes out
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At what age does AS occur?
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some aortic valve calcification occurs with aging
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50% of pts with AS die of ?
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CHF
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Since LV has increased ability to hypertrophy and compensate for a pressure load, watch this pt cardfully for?
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onset angina or effort syncope: with development of CHF, ominous since LV can’t compensate any further.
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With AS on PE, check for?
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SEM, delay in carotid upstroke, delayed 2nd heart sound
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With AS, S2 may be?
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single or paradoxically split, as with calcification and valve rigidity, the aortic valve closure becomes quieter. Note increased force of PMI secondary to LVH
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AS on EKG?
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1 evidence of LVH
2 LA enlargement (biphasic P) 3 strain pattern with severe LVH 4 ST segment depression 5 T wave inversion with asymmetric wave with abrupt upstroke. |
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Cardiomegaly may be noted with which murmurs on CXR?
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AS & MR
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Diagnose AS via?
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echo.
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Management of AS?
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in young pt, no competitive sports
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With elderly, what mandates evaluation?
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effort syncope, CHF development mandates cardiology evaluation.
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With coexisting CHF & AS?
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give dig, Lasix, referral
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MS is heard best in which position?
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at apex especially in the LL decubitus position
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Management for MS includes?
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salt restriction, mild HCTZ and cardiology referral.
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MR On CXR?
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cardiomegaly
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When do you consult cardiology for MR?
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with increased dyspnea.
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Murmurs can be classified by what characteristics?
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1 timing
2 shape 3 location 4 radiation 5 intensity 6 pitch and 7 quality |
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Timing of a murmur, refers to?
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whether the murmur is a systolic or diastolic murmur.
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Shape of a murmur refers to?
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the intensity over time
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Location of a murmur refers to?
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where the heart murmur is auscultated best. There are 6 places on the anterior chest to listen for heart murmurs
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Locations of the heart are?
(correspond to a different part of the heart.) |
The locations are:
2nd Rt intercostal space (Aortic) 2nd Lt ICS (Pulmonic) 3rd Lt ICS (Erbs Point) 4-5 th Lt ICS (Tricuspid Area) MCL 5th ICS (Mitral Area) |
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Radiation of a murmur refers to?
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where the sound of the murmur radiates. The general rule of thumb is that the sound radiates in the direction of the blood flow.
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Intensity of a murmur refers to?
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the loudness of the murmur, and is graded on a scale from 0-6/6.
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The pitch of a murmur is?
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low, medium or high and is determined by whether it can be auscultated best with the bell or diaphragm of a stethoscope.
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Some examples of the quality of a murmur are?
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blowing, harsh, rumbling and musical Continuous murmurs
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