Murmurs

Question 1

What are the only definitive methods of identifying structural and functional abnormalities?

Answer 1

• Echo

- Cardiac Cath

Question 2

• Best heard at 2nd RICS
• radiates to neck and LSB
• midsystolic
• often loud w/ a thrill

Answer 2

Aortic Stenosis

best heard when patient sitting and leaning forward

Question 3

• Best heard at 2nd to 4th LICS
• radiates to apex and RSB
• grade 1-3
• high pitch and blowing

Answer 3

Aortic Regurg

best heard when patient sitting and leaning forward; full exhalation

Question 4

• Best heard at apex w/ little or no radiation
• middiastolic
• grade 1-4
• low pitch
• S1 accentuated
• opening snap follows S2

Answer 4

Mitral Stenosis

best heard w/ patient in LLDB; full exhalation

Question 5

• Best heard at apex w/ radiation to the L axilla
• pansystolic
• medium to high pitch
• blowing
• S2 often decreased
• apical impulse is prolonged

Answer 5

Mitral Regurg

Question 6

• late systolic murmur

- midsystolic click

Answer 6

Mitral Valve Prolapse

most patients are thin female w/ minor chest deformities

Question 7

• murmur at LLSB
• radiation to right sternum and xiphoid area
• holosystolic
• meidum, blowing
• increases slightly w/ inspiration
• JVP often elevated

Answer 7

Tricuspid Regurg

Question 8

• murmur at 2nd and 3rd LICS
• midsystolic
• crescendo-decrescendo
• radiation to L shoulder and neck
• soft to loud; possible thrill
• medium to harsh

Answer 8

Pulmonary stenosis

Question 9

Tx of aortic and mitral valve disorders

Answer 9

only effective long term tx are surgical repair, replacement of defective valve & balloon valvuloplasty
-If good exercise tolerance may tx medically w/ diuretics and vasodilators for pulmonary congestion w/ digoxin or beta-blockers for dysrhythmias

Question 10

In all cases of tricuspid and pulmonic disorders

Answer 10

right sided pressure overload less to right sided cardiomegaly system venous congestion and R sided heart failure

• often present w/ exercise intolerance
• JVD, peripheral edema, and hepatomegaly reflect systemic venous congestion

Question 11

Tx of tricuspid and pulmonic disorders

Answer 11

• sodium restriction and diuretic therapy
• underlying conditions causing pulmonary HTN and tx w/ arterial vasodilators or positive inotropic a gens
• definitive tx = surgical repair, valvuloplasty, or replacement valve