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24 Cards in this Set
- Front
- Back
Mitral stenosis-murmur
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Mid-Diastolic apical rumble c opening snap.
May have Rv lift 2/2 RVH |
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Mitral Stenosis-si/sx
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Dec. flow across MV leads to LAE and RVH, pts develop a-fib
Due to rheum. fever Dyspnea, orthopnea |
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MItral Stenosis-rx
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B-blocker to slow HR
Lasix 40 mg to dec pulm edema *Don't give positive inotropic agents |
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Mitral Valve Prolapse
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Late Systolic murmur c midsystolic click
If symptomatic Atenolol 25mg qd |
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Mitral Regurg-murmur
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High pitched apical blowing holosystolic murmur that radiates to axilla
Laterally placed PMI, systolic thrill |
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Mitral regurg
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Often 2/2 inferior wall MI.
Pulmonary edema, dyspnea, a-fib |
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Aortic Regurg-murmur
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3 Murmurs
-Blowing early diastolic at aorta&LSB -Apical diastolic rumble(Austin Flint. *similar to MS but no opening snap) -Midsystolic flow murmur at base |
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Aortic Regug-PE
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Wide pulse pressure
Double peaked atrial pulse Laterally displaced PMI -cc:dyspnea |
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Tricuspid Regurg
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Diastolic rumble confused with MS but increased with resp.
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Aortic Stenosis-murmur
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Midsystolic crescendo-decrescendo murmur at 2nd rt space.
Radiates to carotids & apex |
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Aotic Stenosis
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Classic Triad: Syncope, angina, exertional dyspnea
* Don't give B-blocker or anti-hypertensive |
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Flow Murmurs
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Short systolic murmurs, 1-2/6,loudest at USB, do not radiate to the neck, asymptomatic
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Diastolic Murmur
1. 2. |
Always pathological
1. Aortic Regurg 2. Mitral Stenosis |
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How can I differentiate between diastolic murmurs of AR and MS?
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The early diastolic, high-pitched descrecendo murmur of AR heard maximally in the 2nd Rt ICS with radiation down the LSB. It almost mimics a breath sound. A wide pulse pressure often accompanies a pulse with a rapid rise and fall. Use a diaphragm and have the patient lead forward with his or her breath held.
In contrast, the MS murmur is low-pitched, mid-diastolic, and heard at the apex. A presystolic crescendo is often heard as the atrial kick sends blood across the stenotic mitral valve. Use a lightly placed bell over the apex, or in the axilla, and ask the patient to lie in the left lateral decubitus position to best hear the murmur of MS |
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What are the key causes of diastolic murmurs?
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1. Aortic regurgitation
2. Mitral stenosis |
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How do I differentiate between the systolic murmurs of AS and MR?
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AS is diamond-shaped (crescendo-decrescendo), heard best at the BASE and radiates to the CAROTIDS.
MR is HOLOSYSTOLIC, heard at the APEX and radiates to the AXILLA |
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Aortic regurgitation (AR) can occur with:
1. 2. 3. 4. 5. |
Aortic regurgitation (AR) can occur with:
1. congenital bicuspid valves 2. rheumatic heart disease 3. endocarditis 3. ankylosing spondylitis 4. rheumatoid arthritis 5. aortic root dilatation/dissection: Marfan's syndrome, aortitis (syphilis, vasculitis |
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How do the clinical presentations of the systolic murmur conditions differ?
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AS-older patients and causes syncope and chest pain and dyspnea.
MR-may present acutely if MI(inferior>anterior)causes a rupture papillary muscle. HCM-young patients with a family history of early cardiac problems Patients may experience few symptoms before a sudden cardiac arrest/event |
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What are common causes of systolic murmurs?
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1. Flow murmurs
2. Aortic Stenosis (AS) 3. Mitral regurgitation (MR) 4. Hypertrophic cardiomyopathy |
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How do I differentiate between the systolic murmurs of AS and MR?
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AS is diamond-shaped (crescendo-decrescendo), heard best at the base and radiates to the carotids.
MR is holosystolic, heard at the apex and radiates to the axilla |
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Aortic regurgitation (AR) can occur with:
1. 2. 3. 4. 5. |
Aortic regurgitation (AR) can occur with:
1. congenital bicuspid valves 2. rheumatic heart disease 3. endocarditis 3. ankylosing spondylitis 4. rheumatoid arthritis 5. aortic root dilatation/dissection: Marfan's syndrome, aortitis (syphilis, vasculitis |
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What are common causes of systolic murmurs?
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1. Flow murmurs
2. Aortic Stenosis (AS) 3. Mitral regurgitation (MR) 4. Hypertrophic cardiomyopathy |
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Mitral Regurg-RX
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Treat pulmonary edema
Nitroprusside to inc. forward flow 5ug/kg/min IV c close monitering Pts hypotensive c nitroprusside add dobutamine 2.5-20 ug/kg/min |
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Aortic Regurg-Rx
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Treat pulmonary edema
Add Nitroprusside & Dobutamine as needed *Ask about phen-fen use |