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Diastolic or Systolic: Mitral regurgitation
Systolic
Diastolic or Systolic: Tricuspid regurgitation
Systolic
Diastolic or Systolic: Aortic stenosis
Systolic
Diastolic or Systolic: Pulmonic stenosis
Systolic
Diastolic or Systolic: Mitral stenosis
Diastolic
Diastolic or Systolic: Tricuspid stenosis
Diastolic
Diastolic or Systolic: Aortic regurgitation
Diastolic
Diastolic or Systolic: Pulmonic regurgitation
Diastolic
Continuous musical hum of grade 1-2 intensity
Venous hum
Where is a venous hum loudest?
Right infraclavicular area
What resolves a venous hum?
Turning the child's neck, placing the child supine, compressing the jugular
What accentuates a venous hum?
Diastole and inspiration
Harsh, diamond-shaped, crescendo-decrescendo systolic ejection murmur heard at the RUSB radiating to the neck (carotid)
Aortic stenosis
What are the 3 symptoms associated with AS?
Exertional dyspnea, angina, syncope
What test is used to diagnose an AS murmur?
TEE
What 2 other physical exam findings are associated with AS?
- Paradoxical split S2
- Pulsus parvus et tardus
High pitched decrescendo diastolic murmur heard best along LLSB (valve) or RLSB (aortic root)
Aortic regurgitation
What murmur may result in a Austin Flint murmur?
Aortic regurgitation
What accentuates an aortic regurgitation murmur?
Sitting up and leaning forward
What 2 abnormal pulses are associated with aortic regurgitation?
Pulsus alternans & Bisferens pulse
Wide pulse pressure presentation with forceful arterial pulse upswing with rapid falloff
Water-Hammer pulse
Unusually large carotid pulsation
Corrigan's pulse
Pulsatile blanching and reddening of fingernails upon light pressure
Quincke's sign
Pulsatile bobbing of the uvula
Muller's sign
To & fro murmur over femoral artery heard best with mild pressure applied to the artery
Duroziez's sign
What is the most important testing used to diagnose aortic regurgitation?
TTE
What is the medical treatment for aortic regurgitation?
Reduce afterload- CCBs (nifedipine), ACEI, ARBs, hydralazine
What is the most common cause of mitral stenosis?
Rheumatic fever
What symptoms are associated with mitral stenosis?
Palpitations, HF, dyspnea (PHD), A fib, Ortner's syndrome
Palpitations, Heart failure, Dyspnea (PHD)- what murmur?
Mitral stenosis
What murmur may be associated with Ortner's syndrome?
Mitral stenosis
Hoarseness due to recurrent laryngeal nerve compression
Ortner's syndrome
Opening snap, low-pitched diastolic rumble, Loud (crisp) S1, Increased P2
Mitral stenosis
Where is mitral stenosis best heard?
Apex in the left lateral decubitus position
Mitral stenosis may present for the first time in __________
Pregnancy
What is the treatment for mitral stenosis?
Percutaneous balloon valvuloplasty
Holosystolic murmur, high-pitched and loud heart at the apex radiating to the left axilla
Mitral regurgitation
What is the most common cause of mitral regurgitation?
Mitral valve prolapse
What symptoms are associated with mitral regurgitation?
Dyspnea, fatigue, PND, orthopnea
What is the best testing for diagnosis of mitral regurgitation?
TEE & color Doppler echo
What can be seen on an EKG of a person with mitral regurgitation?
LVH and LAE
What is the treatment for chronic mitral regurgitation?
Percutaneous MV repair with catheter based clip
What is the most common patient demo for mitral valve prolapse?
Slender, tall females
"Barlow's syndrome"
Mitral valve prolapse
"Click murmur syndrome"
Mitral valve prolapse
What symptoms are rare with mitral valve prolapse?
Edema and HF
Mid systolic click, followed by a late systolic murmur best heard at the apex
Mitral valve prolapse
What is the effect of Valsalva on mitral valve prolapse?
More holosystolic, louder, earlier click
What is the effect of squatting on mitral valve prolapse?
Shorter, delayed click
What is the best testing for diagnosis of mitral valve prolapse?
TEE
Is endocarditis prophylaxis recommended for patients with mitral valve prolapse?
No
What is the symptomatic treatment (palpitations) for mitral valve prolapse?
Beta blockers
Systolic crescendo-descrescendo ejection murmur in the left upper sternal border that increases with inspiration and radiates diffusely
Pulmonic stenosis
What symptoms associated with pulmonic stenosis may develop?
RVH, JVD, RV ischemia
When is pulmonic stenosis usually detected?
Childhood- congenital
What is the most common cause of primary pulmonic regurgitation?
Congenital abnormality
What are causes of secondary pulmonic regurgitation?
Pulmonary HTN, Dilated cardiomyopathy
Crescendo-decrescendo early diastolic murmur heard at the LUSB
Pulmonic regurgitation
What condition is associated with a Graham Steell murmur?
Pulmonic regurgitation
High-pitched early diastolic descrescendo murmur heard over the LUSB, a result of high-velocity regurgitant flow across an incompetent pulmonic valve
Graham Steell murmur
What symptoms may be associated with pulmonary regurgitation?
RHF symptoms
When tricuspid regurgitation is due to rheumatic heart disease, it generally occurs in combination with __________
Tricuspid stenosis
What is the most common congenital form of tricuspid regurgitation?
Ebstein anomaly
Injection of foreign agents into venous system (IVDA) hits the ________ valve FIRST
Tricuspid
High pitch blowing pansystolic murmur at the 4th ICS LSB
Tricuspid regurgitation
What symptoms are associated with tricuspid regurgitation?
Symptoms of RHF
Patient with a hx of IVDA presents with Osler nodes, Janeway lesions, and Roth spots. What condition are you thinking & what is the associated murmur?
Bacterial endocarditis, Tricuspid regurgitation
What is a normal ejection fraction?
55-70%
What does Frank-Starling's Law state?
The greater the EDV, the greater the SV
Abnormally uncomfortable awareness of breathing
Dyspnea
Dyspnea upon assuming the supine position
Orthopnea
Dyspnea upon assuming the lateral decubitus position
Trepopnea
Dyspnea upon assuming the upright position
Platypnea
What NYHA Classification:
Patients with no limitation of activities; they suffer no symptoms from ordinary activities
Class I
What NYHA Classification:
Patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion
Class II
What NYHA Classification:
Patients with marked limitation of activity; they are comfortable only at rest
Class III
What NYHA Classification:
Patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest
Class IV
The obliteration of the window that appears when placing the fingertips together
Schamroth's sign
A positive Schamroth's sign is indicative of _______
Clubbing
Xanthelasma palpebrarum and Xanthoma are signs of ________
Familial dyslipidemia
What JVP wave is due to atrial contraction?
A wave
What JVP wave is due to bulging of tricuspid valve with ventricular systole?
C wave
What JVP wave is due to atrial relaxation?
X wave
What JVP wave is due to ventricular filling?
V wave
What JVP wave is due to tricuspid valve opening & atrial emptying?
Y wave
A giant A wave might be indicative of ______
Tricuspid/Pulmonary stenosis or RV HF
A cannon A wave might be indicative of ______
Complete heart block, junctional rhythm, or V tach
A giant V wave might be indicative of ______
Tricuspid regurgitation
A prominent X and Y descent might be indicative of ______
Constrictive pericarditis, RV HF
What is a normal JVP?
3-4 cm above the sternal angle
What is a normal pulse pressure in healthy patients?
40 mmHg
What is a normal mean arterial pressure in healthy patients?
60-100 mmHg
Marked attenuation in the amplitude of the pulse during the inspiratory phase of usual respiration, exceeds 10 mmHg fall in systolic BP
Pulsus paradoxus
What pulse is seen in cardiac tamponade?
Pulsus paradoxus
A pulse that is slow in rising and late in peaking
Pulsus tardus
Pulsus tardus may be seen in ________
Aortic stenosis
Bifid, arterial pulse perceived as 2 narrowly separated positive waves during systole
Bisferiens pulse
What pulse may be seen with HOCM?
Bisferiens pulse
What pulse may be seen with aortic regurgitation (especially if there is concomitant aortic stenosis)?
Bisferiens pulse
Water-Hammer pulse is seen with _______
Aortic regurgitation
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