Heart Murmurs, Edema, Palpitations

Flashcards for Heart Murmurs, Edema, and Palpitations

What causes heart murmurs?

Audible vibrations due to increased turbulence from accelerated blood flow through normal or abnormal orifices.

What defines systolic murmurs in terms of timing?

Begins with or after the first heart sound (S1) and terminate at or before the component of the second heart sound (S2).

What defines continuous murmurs in terms of timing?

Not confined to either phase of the cardiac cycle; begin in early systole and proceed through S2 into all or part of diastole.

What are the possible configurations of a heart murmur?

Crescendo, Decrescendo, Crescendo-decrescendo, Plateau

Murmurs of what intensity usually signify important structural heart disease?

Grade 3 or greater intensity.

What recognition helps facilitate accurate identification of a murmur?

Recognition of the location and radiation of the murmur.

What is the timing characteristic of early systolic heart murmurs?

Begins with S1 and ends well before S2.

Give examples of conditions that cause early systolic murmurs.

Acute mitral regurgitation, Tricuspid regurgitation, Ventricular septal defect

What is a unique characteristic of tricuspid regurgitation murmur?

Increases intensity with inspiration; Carvallo sign.

What are the timing characteristics of mid systolic murmurs?

Begin at a short interval after S1 and end before S2.

Give examples of conditions that cause mid systolic murmurs.

Aortic stenosis, Pulmonic stenosis, Hypertrophic Obstructive Cardiomyopathy

Where is the best place to hear a Hypertrophic Obstructive Cardiomyopathy murmur?

Left sternal border.

What are the timing characteristics of late systolic murmurs?

Begins late after S1 and ends just before S2.

Give examples of conditions that cause late systolic murmurs.

Mitral valve prolapse, Tricuspid valve prolapse

What are the characteristics of chronic aortic regurgitation (AR) murmurs?

High-pitched, blowing, decrescendo; early to mid-diastolic starting after the aortic component of S2 (A2).

Where is the chronic aortic regurgitation (AR) murmur best heard?

2nd Right ICS and along the left sternal border.

What could radiation of an Aortic regurgitation murmur indicate?

Aortic root disease - Murmur radiates along the Right sternal border

Name a murmur associated with chronic, severe aortic regurgitation (AR).

Austin Flint Murmur

What are the characteristics of an Austin Flint murmur?

Lower-pitched; mid to late diastolic

What helps differentiate Austin Flint Murmur from Mitral Stenosis?

No OS in aortic regurgitation but present in mitral stenosis.

A wide pulse pressure, water-hammer carotid pulse and Quincke’s pulsations are associated with what murmur?

Peripheral signs of severe chronic AR.

What are the characteristics of pulmonic regurgitation (PR) murmurs?

Decrescendo, early to mid-diastolic murmur (Graham Steell murmur); begins after pulmonic component of S2 (P2).

What is the most common cause of pulmonic regurgitation (PR) murmurs?

Dilation of the pulmonic valve annulus from chronic pulmonary hypertension.

What clinical signs help distinguish between PR and AR?

Pulmonary hypertension signs.

What results in Mid Diastolic Murmurs?

Obstruction and/or augmented flow at the level of the mitral or tricuspid valve.

What are the murmur characteristics of a mid diastolic murmur?

Low-pitched, loudest at the left ventricular apex, often appreciated in the left lateral decubitus position.

What is the most common cause of mid diastolic murmurs?

Rheumatic fever.

Name an associated sound heard with mid diastolic murmurs.

OS - a high-pitched sound occurring shortly after S2

What increases murmur intensity with maneuvers that raise cardiac output and mitral valve flow, like ____?

Exercise

What are the murmur characteristics of a mid-diastolic murmur associated with tricuspid stenosis?

Best heard at the lower left sternal border and increases in intensity with inspiration (Carvallo’s sign).

Give a classic condition / example of a condition causing continuous murmurs.

Patent Ductus Arteriosus (PDA)

What is Patent Ductus Arteriosus (PDA)?

Abnormal communication between the aorta and pulmonary arteries.

What are the characteristics of a Patent Ductus Arteriosus (PDA) murmur?

Continuous, machine-like murmur.

What is a ruptured sinus of Valsalva (Valsalva aneurysm)?

Rupture of the sinus valsalva leads to an abnormal communication between the aorta and the right atrium or right ventricle, creates an aortic-right atrial or right ventricular fistula.

What characterizes Coarctation of the Aorta?

Narrowing of the aorta.

Why can a continuous murmur can be heard along the course of one of the ribs in Coarctation of the Aorta?

enhanced blood flow in the intercostal collateral arteries, which develop as a way to bypass the narrowing in the aorta.

What is “To and fro” heart murmur?

Cervical bruit heard in both the systolic and diastolic phases.

What happens to right-sided heart sounds during respiration?

Increase in intensity with inspiration.

What happens to left-sided heart sounds during respiration?

Increase in intensity with expiration.

What is the effect of squatting on murmur sounds?

Increases MR, AR, VSD murmurs and decreases HOCM, MVP murmurs

What is the effect of standing on murmur sounds?

Increases HOCM, MVP murmurs and decreases MR, AR, VSD murmurs

How does accurate identification of heart murmur begins?

accurate identification of a heart murmur begins with a systematic approach to cardiac auscultation.

Echocardiography

valuable tool for the assessment of cardiac murmurs, information regarding valve structure and function, chamber size, wall thickness, ventricular function, estimated pulmonary artery pressures, intracardiac shunt flow, pulmonary and hepatic vein flow, and aortic flow.

What does edema represent?

Represents an excess of interstitial fluid.

What are factors that contributing to the development of Edema?

Increase in intracapillary hydrostatic pressure, inadequate lymphatic drainage, reductions in the oncotic pressure in the plasma, damage to the capillary endothelial barrier, increases in the oncotic pressure in the interstitial space.

What are diagnostic indicators of nephrotic syndrome and other hypoalbuminemic states?

Diminished colloid oncotic pressure due to losses of large quantities (23.5 g/d) of protein into the urine. Hypoalbuminemia (<3.0 g/dL)

What are heart palpitations?

Thumbing, pounding, or fluttering sensations in the chest.

What are cardiac etiologies for heart palpitations?

Premature atrial and ventricular contractions; supraventricular and ventricular arrhythmias

How do you differentiate patients with psychiatric causes of palpatations

patients with psychiatric causes for palpitations more commonly report a longer duration of the sensation (>15 mins) and other accompanying symptoms

What are resting 12 Lead ECG used for?

Used to document arrhythmia.