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YR3: MM FC Ed. > 30. Heart Murmurs > Flashcards

30. Heart Murmurs Flashcards

1
Q

What sound is S1? What causes this? When does this occur?

A

LUB
closing of mitral + tricuspid valves
At start of systolic contraction of ventricles

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2
Q

What sound is S2? What causes this? When does this occur?

A

DUB
Closing of aortic + pulmonary valves
After systolic contraction is complete (to prevent backflow)

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3
Q

What sound is S3? What causes this? When does this occur?

A

Lub(S1)- De(S2)-Dub(S3)
Rapid ventricular filling causing chordae tendonae to pull to full length
Subtle
.1s after 2nd heart sound

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4
Q

When is S3 normal? When is S3 pathological?

A

Normal: 15-40 yr olds
Pathological: older patients- can indicate HF as ventricles + chordae are stiff + weak

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5
Q

What sound is S4? What causes this? When does this occur?

A

Le (S4)- Lub (S1)- Dub (S2)
Turbulent flow from atria contracting against a ventricle that is non compliant.
Heard directly before S1

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6
Q

Is S4 normal? What does the presence of S4 suggest?

A

ALWAYS ABNORMAL

Indicates stiff or hypertrophic ventricle

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7
Q

List the 4 sites to auscultate for murmurs

A

Aortic valve 2nd ICS right sternal border
Pulmonary valve 2nd ICS left sternal border
Tricuspid valve 5th ICS left sternal border
Mitral valve 5th ICS MCL

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8
Q

What is ERBs point and why auscultate here?

A

Best place to listen to heart sounds (S1-4)

3rd ICS left sternal border.

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9
Q

How would you position a patient to listen for mitral stenosis?

A

Roll patient onto left hand side

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10
Q

How would you position a patient to listen for aortic regurgitation?

A

Sit patient up
Lean them forward
Ask them to take deep breath out + hold

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11
Q

What mnemonic can be used to assess heart murmurs?

A

SCRIPT
Site: Where is it loudest?
Character: Soft? Blowing? Crescendo? Decrescendo?
Radiation: can you hear murmur going to carotids? (AS) or left axilla? (MR)
Intensity: Grade?
Pitch: high pitched? low + grumbling? (velocity)
Timing: Systolic? Diastolic?

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12
Q

How do you grade a murmur?

A 
1 = difficult to hear
2 = quiet
3 = Easy to hear
4 = Easy to hear with palpable thrill
5 = Hear with stethoscope barely touching chest
6 = Hear with stethoscope off chest, just holding nearby
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13
Q

Describe what commonly causes a heart to hypertrophy

A

When heart muscle is pushing against a stenotic valve, it has to work a lot harder to get blood through that valve

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14
Q

Describe the pathological effect of mitral stenosis on the heart

A

LA has to work really hard to push blood through the mitral valve, thus results in LA hypertrophy

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15
Q

Describe the pathological effect of aortic stenosis on the heart

A

LV has to work really hard to push blood through the aortic valve, thus results in LV hypertrophy

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16
Q

Describe what commonly causes heart dilatation

A

A leaky valve, allowing blood to flow back into the chamber stretches the muscle

17
Q

Describe the pathological effect of mitral regurgitation on the heart

A

Blood flows back through the mitral valve into the LA, thus results in LA dilatation

18
Q

Describe the pathological effect of aortic regurgitation on the heart

A

Blood flows back through the aortic valve into the LV, thus results in LV dilatation

19
Q

Give 2 causes of mitral stenosis

A

Rheumatic heart disease

Infective endocarditis

20
Q

Describe the murmur heard in mitral stenosis

A

Mid diastolic
Low pitched
Rumbling
Due to low velocity of blood flow

21
Q

What sound is heard in mitral stenosis?

A

LUB! Dub Durrrrrr

Loud S1 as thick valves require large systolic force to shut

22
Q

What 2 things may be found on examination in mitral stenosis?

A

Malar flush

Palpable tapping apex beat

23
Q

What rhythm is mitral stenosis associated with?

A

Atrial fibrilation

24
Q

Give 5 causes of mitral regurgitation

A 
Idiopathic weakening of valve with age
IHD
Infective endocarditis
Rheumatic heart disease
Connective tissue disorders e.g. Marfaans
25
Q

Describe the murmur heard in mitral regurgitation

A

Pan-systolic
High pitch whistling (High velocity through leaky valve)
Radiates to left axilla

26
Q

What sound is heard in mitral regurgitation?

A

BURRRR (throughout systole)

27
Q

What is mitral regurgitation associated with?

A

Congestive heart failure- leaking valve causes reduced ejection fraction, causes backlog of blood waiting to pass through left side of heart ∴ may hear S3 if HF present

28
Q

Give 3 causes of aortic stenosis

A

Idiopathic age related calcification
Congenital bicuspid valve
Rheumatic heart disease

29
Q

Describe the murmur heard in aortic stenosis

A

Ejection systolic- occurs while blood is being ejected from LV
High pitched
Crescendo-Decresendo due to speed of blood flow at different points of systolic contraction
Radiates to carotids as turbulence continues up to the neck

30
Q

What sound is heard in aortic stenosis?

A

BURRRR-DUB

31
Q

Give 2 signs on examination that aortic stenosis is associated with

A

Slow rising pulse

Narrow pulse pressure

32
Q

Symptoms of what may accompany aortic stenosis?

A

Exertional syncope due to difficulty maintaining blood flow to the brain through that narrow valve

33
Q

Give 2 causes of aortic regurgitation

A

Idiopathic age related weakness

Connective tissue disorders (Erhlers Danlos syndrome, Marfans)

34
Q

Describe the murmur heard in aortic regurgitation

A

Early diastolic (Blood flow back through aortic valve happens during diastole)
Soft
VERY subtle

35
Q

What sound is heard in aortic regurgitation?

A

Lub-tarrrr

36
Q

What sign on examination is aortic regurgitation associated with?

A

Collapsing Pulse: rapidly appears then disappears as blood is pumped out of the ventricles then immediately starts flowing back through the aortic valve into the ventricles

37
Q

What does aortic regurgitation often result in?

A

HF due to the back pressure of blood waiting to get back through the left hand side of the heart

38
Q

What murmur may aortic regurgitation cause?

A

Austin Flint murmur
Heard at Apex
Early diastolic rumbling murmur

39
Q

What is the most likely cause of a new onset pansystolic murmur in an IV drug user with fever?

A

Tricuspid regurgitation

due to infective endocarditis (S. aureus growing on tricuspid valve)

YR3: MM FC Ed. (46 decks)

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