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***Heart murmurs wriiten chart of what to expect - Excellent!
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Overview of Heart Murmurs | almostadoctor.com - free medical student revision notes
murmur summary - awesome! For physical exam test.
Just incredible. Resource for atypical heart sounds!
Murmur Type Where Heard Radiates Symptoms Associations Info Aortic stenosis Ejection systolic 2nd right intercostal space, left sternal edge Carotids Hypotension, cold peripheries, left ventricular enlargement, dyspnoea, angina, syncope, sudden death, slow rising carotid pulse, can cause an aortic thrill Ejection click, Heaving apex beat, JVP – slow rising with plateau More clinically severe than mitral regurg. The stenosis can be very severe, even when no murmur is present (or the murmur is very quiet). Can be caused by a congenital defect of the valve (where it only has two cusps), or by calcification of a normal three cusp valve. Can also be caused by rheumatic heart disease, and rarely, a large atheroma when there is sever hypercholesterolaemia. Mitral Regurgitation Pan-systolic Apex Axilla Often caused by left ventricular dilatation – thus the apex beat is displaced, and signs of heart failure may be present, also AF Generally quieter, and longer duration than aortic stenosis. The second heart sound may be absent. The murmur is generally uniform and lasts the whole of systole. The sound is likely to be low pitched, and thus, best heard with the bell, but you should listen with the diaphragm as welll Mitral Prolapse Late-systolic Apex Axilla Mid-systolic click Similar to mitral regurg. However, the murmur will first be audible half way through systole (not at the start), and will be preceded by the characteristic click of a prolapsing valve. Aortic regurgitation Early diastolic Left sternal edge, 4th IC space ? JVP – this may be fast rising and fast falling – ‘water-hammer pulse’, displaced apex beat, nailbed pulsations, collapsing pulse, head nodding in time with heartbeat, Corrigan’s sign – prominent carotid pulsation, BP higher in legs than in arms Sometimes S3 – when there is associated LV hypertrophy It will often initially sound high pitched, then will die away. Best heard with the patient sat upright in bed at the left sternal angle, with the patient holding their breath at the end of full expiration. This brings the valve closest to the stethoscope. Best heard with the bell Mitral stenosis Mid- diastolic Mitral area Often associated with AF. Opening snap It is rare to hear this anywhere other than the mitral area. It can be heard better if you get the patient to lie on their left hand side as this brings the valve closer to the stethoscope Acute pericarditis ‘to and fro’, or triple Left sternal edge, sat upright, full expiration ----------- Symptoms of pericarditis; sharp retrosternal pain (may radiate to the shoulders and neck), fever, Pericardial friction rub Can vary from hour to hour, like the pain of pericarditis, thought to be caused by the inflamed surfaces of the visceral and parietal pericardium rubbing together when they are inflamed. In severe effusion (tamponade) the sound may be absent due to the amount of fluid present Innocent flow murmurs Pan systolic ? ? These are normal sounds in children and young adults - Caused by the flow of blood over the valves, they often have a musical tone Split S2 - - - - - When there is a wide fixed splitting of S2 that is not altered by respiration, this is likely to be caused by a atrial septal defect. Also, splitting of S2 is a normal finding; especially during inspiration. This is becausein inspiration, the diaphragm contracts, and the venous return to the heart is increased. Thus, the right side of the heart takes longer to fill, and so the sound is split Atrial Plop Diastolic ? ? This is a sign of atrial myxoma. There may be signs of cerebrovascular damage (stroke) Atrial myxoma is a non-cancerous tumour that can occur in the left or right atria. It grows on the atrial septum. it can embolise and cause strokes. A myxoma is a primary tumour of the heart. About 75% of them occur on the left side. They are rare. They are more common in families, and there is a genetic component. S3 - Mitral area - Normal finding in fit young people, and pregnant women. Thought to be caused by rapid filling of the heart. Also present in left ventricular failure – because even though filling is slow, the ventricle is non-compliant. Mitral and aortic regurg This is a low pitched sound, and thus best heard with the bell. It occurs right after S2, and may sound like a double S2. It is often present in mitral and aortic regurgitation, because the stroke volume (and thus filling speed) is very high to cope with the regurgitation. S4 - Mitral area Found in aortic stenosis, hypertension, CCF, hypertrophic obstructive cardiomyopathy Aortic stenosis This is also low pitched, and best heard with the bell. This is never a normal finding. It results from atrial contraction pushing the last bit of blood into the ventricle – thus is present when there is a non-compliant ventricle. Machinery murmur Systolic Usually asymptomatic Can also be heard quietly in diastole. Caused by a patent ductus arteriosus. This is a congenital anastomosis between the pulmonary and aortic circulation, that normally closes off at birth. Systolic murmurs are easiest to hear, but it is more difficult to decide what type they are Don’t forget to feel for the carotid to know whether they are systolic or diastolic! - Systole – between S1 and S2 - Diastole – between S2 and S3 Left sided murmurs are best heard on Expiration Right sided heart murmurs are best heard on Inspiration Left sided murmurs are the ones you are more bothered about! Infective Endocarditis can cause any murmur, but is most likely to cause regurgitation.
Overview of Heart Murmurs
Pretty clever... My daughter broker her flip flop at school and the school nurse fixed it for her.
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Pretty clever... The things a school nurse does.
Pretty clever... My daughter broker her flip flop at school and the school nurse fixed it for her.... WISH I would have thought of this..
Wow...this would be great for the school nurse, or even a teacher who has more than one child in class who who has severe allergies and carries an epi-pen.
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Family pack of epi pens
Welcome to EPI-ACCESS INTERNATIONAL Inc. - Teacher's Case
Insulin This chart is GREAT! After all of these years of nursing...I still need a reference!
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After all of these years of nursing school, I still need a reference!
Nurse Eye Chart PRINTABLE. Nurses Heal With Love and Bandaids. Nurse Appreciation. Doctor's Office Decor. School Nurse Wall Art.
Nurse Eye Chart PRINTABLE. Nurses Heal With Love and Bandaids. #printable
Nursing Skills Playlist 75 videos some of these are nice refreshers!!
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75 videos to help your master essential nursing skills
Youtube nursing skills videos
Love Janet Evanovich!