52 - murmur Flashcards
what is the 1st heart sound
closing tricuspid / mitral
Systolic murmurs
Aortic and pulmonary stenosis. AV regurg.
Diastolic murmurs
Aortic and pulmonary regurg. AV stenosis
murmur in hypertrophic cardiomyopathy
systolic murmur heard best at lower sternal border. Valsalva increases venous return and makes the murmur louder.
murmur in PDA
Continuous machinery murmur radiating to back.
3 basic Ix for murmur with Sx
ECG, CXR, ECHO
Causes of AS
congenital, rheumatic fever, aging, atherosclerosis
Rfs for AS
smoking HTN, cholesterol, diabetes,
Drugs CI in AS
Beta blockers, Ace inhibitors and nitroglycerin
Signs of AS
Orthopnea, PND, swollen legs, pallor, flushing, slow rising pulse
Bicuspid AV murmer heard where? Other sign on examination
murmur at right 2nd intercostal space. May have differences in blood pressure between arms and legs.
AR sx
breathlessness on exertion, orthopnea, angina, cyanosis, palpitations, PND.
Hypertrophy where in AS
LV
Cause od AR
Most cases are idiopathic. Known to be associated with aging, syphilis, Marfans, Ehler-Danlos, Behcets and other seronegative diseases
Mx of AR
If disease is stable, treat with ACE inhibitors to decrease afterload.
Surgery reserved for severe disease as is an open heart procedure.
Usual cause of PS
Congenital
Mx of PS
Replacement / balloon valvuloplasty
PR causes
pulmonary hypertension, Tetralogy of Fallot, rheumatic fever, endocarditis, Ehler-Danlos, Marfans,
What does PR ->?
Right heart failure and diastolic murmur ]
RVH
MS sx
Chest pain, palpitations, haemoptysis, weakness, malar flash and fatigue.
Ms -> ?
heart failure with dyspnoea, ascites and oedema
Mx of symptomatic MS
valve replacement/balloon dilation. Manage symptoms (i.e. angina with GTN etc.)
Usual cause of MS
Rheumatic fever
What happens in mitral insufficiency / prolapse
Mitral valve not fully patent or does not closed properly. Blood flows backwards into the left atrium.
Signs of Mitral insufficiency
signs of congestive heart failure: SOB at rest, orthopnea, PND, pulmonary oedema, tachycardia.
Pansystolic murmur and a 3rd heart sound.
Prolapse produces a systolic click.
What may mitral insufficiency ->
cardiogenic shock
AF
Causes of mitral insufficiency
post-MI, rheumatic fever, Ehler-Danlos, Marfans, endocarditis (most common),
Tricuspid regurge signs
Produces a right sided heart failure: ascites, peripheral oedema.
Third heart sound and pansystolic murmur.
Liver may be pulsatile.
RVH
Causes of tricuspid regurge
pulmonary hypertension, rheumatic fever, endocarditis, Ebstein anomaly, MI, chronic lung disease,
Mx of TR
Manage heart failure with ACE inhibitors and suitable diuretics
TS cause and always with?
caused by rheumatic fever and accompanied by mitral valve disease.
prophylaxis in valvular heart disease? Who wlse gets this?
Against infective endocarditis (S aureus and viridans most common)
Oral health is important.
Amoxicillin 2g PO. Prior to surgical and dental procedures.
Also applies to those with Hypertrophic cardiomegally,
PMHx of endocarditis and those with prosthetic valves or transplants.
Signs of cyanotic heart disease
Clubbing, cyanosis, crouching posture, crying, rapid breathing and heart rate, delayed development.
Sx of PDA
raised WOB, failure to thrive, CHF, machinery murmur, cardiomegaly, tachycardia, cyanosis,
Mx of PDA
NSAIDs
if fail - percutaneous surgery
When would you not treat PDA
If great vessels are transposed, this needs to remain patent; prostaglandins given until corrective surgery has been provided.
What happens in coarctation of the aorta?
Aorta narrows around the ductus arteriosus.
Causes left ventricular hypertrophy to compensate.
What is marfans ? phenotype?
Connective tissue disorder.
Autosomal dominant.
Phenotype of a tall thin, long limbed person. Increased risk of scoliosis and joint flexiblity. Other abnormalities: pectus excavatum, flat feet, hammer toes, arched palate,
Thumb sign and other Ghent criteria
Marfans complications
Mitral valve prolapse, aneurysms, osteoarthritis, GORD, aortic dissection, pneumothorax,
Mx of Marfans
No cure.
Requires regular cardio check ups.
Beta blockers (metoprolol) and losartan
