Term
| Causes of widened splitting |
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Definition
Right bundle branch block, pulmonary stenosis
A2 ALWAYS before P2, increased gap on inspiration |
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Term
| Causes of fixed splitting |
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Definition
atrial septal defect
A2 ALWAYS before P2 with NO change on inspiration |
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Term
| Causes of Paradoxical splitting |
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Definition
Left bundle branch block, advanced aortic stenosis
P2 close before A2 |
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Term
| Causes of ejection clicks |
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Definition
occur shortly after S1 and coincide with OPENING of aortic or pulmonic valves; sharp high pitched, indicate presence of aortic or pulmonic valve stenosis
Pulmonic will decrease intensity during inspiration; aortic stays the same |
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Term
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Definition
| Occurs after S2 due to opening of stenosed mitral or tricuspid valve; sharp high pitched sound and doesn't vary with respiration |
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Term
| how can you tell the severity of a MS or TS? |
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Definition
severity of stenosis can be approximated by time interval between A2 and opening snap; a shorter time interval means a more severe (advanced) stenosis
This is because severe stenosis-->increased atrial pressure (over time)-->valve pushed open earlier by the increased pressure |
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Term
| what is a ventricular gallop referring to? |
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Definition
| a pathologic S3-->due to volume overload due to CHF, or increased transvalvular flow accompanying advanced mitral or tricuspid regurge |
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Term
| what is an atrial gallop referring to? |
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Definition
the presence of an S4-->presence of a stiff ventricle (that's what she said...)
stiff ventricle is due to decreased ventricular compliance resulting from ventricular hypertrophy or myocardial ischemia |
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Term
| what is a summation gallop? |
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Definition
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Term
| Condition causing a continuous murmur that builds up from S1, peaks at S2 and descends to S1 |
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Definition
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Term
| Murmurs causing early decrescendo at S2 to S1 |
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Definition
| Aortic or Pulmonic Regurge |
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Term
| Murmurs after S2 causing mid to late decrescendo starting from an opening snap and then building to S1 |
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Definition
| mild mitral or tricuspid stenosis |
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Term
Murmurs after S2 causing prolonged mid to late decrescendo from opening snap and then building before S1
time from S2 to Opening Snap decreased |
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Definition
| severe mitral or tricuspid stenosis |
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Term
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Definition
aortic stenosis and regurgitation
pulmonic stenosis and regurgitation |
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Term
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Definition
| •a wave: small rise in right atrial pressure due to right atrial contraction |
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Term
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Definition
| •c wave: small rise in right atrial pressure as the tricuspid valve closes and bulges toward the right atrium |
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Term
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Definition
| •v wave: rise in right atrial pressure during ventricular systole, when the tricuspid valve is (supposedly) closed |
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Term
NAME That MURMUR!
Crescendo-Decrescendo midsystolic murmur heard at 2RSB radiating to the carotids. Palpation of carotid arteries reveals weakened, late pulse. |
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Definition
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Term
NAME That MURMUR!
Mid-diastolic, low pitched rumble, best heard in lateral recumbent position |
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Definition
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Term
NAME That MURMUR!
Mid-diastolic, low pitched rumble, best heard in lateral recumbent position, louder on inspiration |
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Definition
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Term
| Patient presents with scratchy triphasic rub at the left sternal boarder. He has a HR<120bpm. It is best heard when the patient completely expires and holds |
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Definition
| pericardial friction rub-->acute pericarditis |
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Term
NAME that MURMUR!
cresendo-decresendo systolic murmur that gets louder with valsalva, amyl-nitrates, and standing. |
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Definition
| Hypertrophic cardiomyopathy |
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Term
| Patient presents with hypotension, jugular venous distention, and muffled/distant heart sounds. Pulse pressure is greater than 10mm Hg during quiet breathing. |
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Definition
Pericardial tamponade
Becks triange (fist three symptoms)
w/ Pulsus paradoxus |
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Term
NAME that MURMUR!
late systolic murmur, midsystolic click |
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Definition
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Term
NAME that MURMUR!
Holosystolic murmur that doesn't get louder during inspiration, best heard at lower left sternal boarder, harsh in quality |
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Definition
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Term
NAME that MURMUR!
Early diastolic, begins w/ loud pulmonic of S2, decrescendo, high pitched, blowing, louder during inspiration, 2 to 4th ICS, LSB |
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Definition
| Graham Steele-->Pulmonic Insufficiency |
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Term
NAME that MURMUR!
Mid diastolic
Begins after pulmonic component of S2
Crescendo-decrescendo
Low-pitched
Gets louder during inspiration
Best heard with bell of stethoscope at 3rd to 4th ICS, LSB |
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Definition
| Pulmonic insufficiency due to deformity of the pulmonic valve |
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Term
NAME that MURMUR!
•Holosystolic murmur
•Gets louder during inspiration (aka Carvallo’s sign)
•Pulsatile jugular venous distention (JVD)
•Pulsatile liver |
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Definition
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Term
NAME that MURMUR!
Crecendo-Decrecendo Systolic murmur
Gets worse with inspiration
ejection sound (that goes away with inspiration)
Doesn’t radiate to carotids
2LSB |
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Definition
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Term
NAME that MURMUR!
Early diastolic Decrescendo
High-pitched “Blowing”
Best heard with diaphragm of stethoscope at 3L or RSB, with patient leaning forward, during held, deep, end-exhalation |
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Definition
| Aortic Regurge/Insufficiency |
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Term
NAME that MURMUR
Diastolic RUMBLE best heard w/ bell @apex |
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Definition
Austin Flint Murmur (Aortic Insuff)
Thought to be due to “functional” mitral stenosis resulting from the aortic regurgitant jet forcing the anterior mitral leaflet into a partially closed position
OR…..
Diastolic rumble results from fluttering of the anterior mitral leaflet caused by the aortic regurgitant jet |
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Term
For $1,000,000 and an A+ on your PBL exam:
Name the three murmurs of aortic insufficiency |
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Definition
| Austin Flint, systolic ejection sound, and a primary (Early diastolic Decrescendo High-pitched, “Blowing”) |
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Term
| Causes of diastolic murmurs |
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Definition
-Insufficiency of either ventricular outflow valve (AR/AI, PR/PI
-Stenosis of either atrioventricular valve (MS, TS) |
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Term
| Differentiate Chronic and Acute Mitral Regurgitation |
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Definition
Chronic
•Holosystolic (pansystolic) murmur
•Doesn’t get louder during inspiration
•Usually best heard at the cardiac apex, sometimes radiating to the left axilla
•Gets louder during isometric handgrip, sudden squatting, or vasopressor administration (all increase R)
Acute
•Early systolic decrescendo murmur |
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