52 - murmur

Question 1

what is the 1st heart sound

Answer 1

closing tricuspid / mitral

Question 2

Systolic murmurs

Answer 2

Aortic and pulmonary stenosis. AV regurg.

Question 3

Diastolic murmurs

Answer 3

Aortic and pulmonary regurg. AV stenosis

Question 4

murmur in hypertrophic cardiomyopathy

Answer 4

systolic murmur heard best at lower sternal border. Valsalva increases venous return and makes the murmur louder.

Question 5

murmur in PDA

Answer 5

Continuous machinery murmur radiating to back.

Question 6

3 basic Ix for murmur with Sx

Answer 6

ECG, CXR, ECHO

Question 7

Causes of AS

Answer 7

congenital, rheumatic fever, aging, atherosclerosis

Question 8

Rfs for AS

Answer 8

smoking HTN, cholesterol, diabetes,

Question 9

Drugs CI in AS

Answer 9

Beta blockers, Ace inhibitors and nitroglycerin

Question 10

Signs of AS

Answer 10

Orthopnea, PND, swollen legs, pallor, flushing, slow rising pulse

Question 11

Bicuspid AV murmer heard where? Other sign on examination

Answer 11

murmur at right 2nd intercostal space. May have differences in blood pressure between arms and legs.

Question 12

AR sx

Answer 12

breathlessness on exertion, orthopnea, angina, cyanosis, palpitations, PND.

Question 13

Hypertrophy where in AS

Answer 13

LV

Question 14

Cause od AR

Answer 14

Most cases are idiopathic. Known to be associated with aging, syphilis, Marfans, Ehler-Danlos, Behcets and other seronegative diseases

Question 15

Mx of AR

Answer 15

If disease is stable, treat with ACE inhibitors to decrease afterload.

Surgery reserved for severe disease as is an open heart procedure.

Question 16

Usual cause of PS

Answer 16

Congenital

Question 17

Mx of PS

Answer 17

Replacement / balloon valvuloplasty

Question 18

PR causes

Answer 18

pulmonary hypertension, Tetralogy of Fallot, rheumatic fever, endocarditis, Ehler-Danlos, Marfans,

Question 19

What does PR ->?

Answer 19

Right heart failure and diastolic murmur ]

RVH

Question 20

MS sx

Answer 20

Chest pain, palpitations, haemoptysis, weakness, malar flash and fatigue.

Question 21

Ms -> ?

Answer 21

heart failure with dyspnoea, ascites and oedema

Question 22

Mx of symptomatic MS

Answer 22

valve replacement/balloon dilation. Manage symptoms (i.e. angina with GTN etc.)

Question 23

Usual cause of MS

Answer 23

Rheumatic fever

Question 24

What happens in mitral insufficiency / prolapse

Answer 24

Mitral valve not fully patent or does not closed properly. Blood flows backwards into the left atrium.

Question 25

Signs of Mitral insufficiency

Answer 25

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.

Question 26

What may mitral insufficiency ->

Answer 26

cardiogenic shock

AF

Question 27

Causes of mitral insufficiency

Answer 27

post-MI, rheumatic fever, Ehler-Danlos, Marfans, endocarditis (most common),

Question 28

Tricuspid regurge signs

Answer 28

Produces a right sided heart failure: ascites, peripheral oedema.

Third heart sound and pansystolic murmur.

Liver may be pulsatile.

RVH

Question 29

Causes of tricuspid regurge

Answer 29

pulmonary hypertension, rheumatic fever, endocarditis, Ebstein anomaly, MI, chronic lung disease,

Question 30

Mx of TR

Answer 30

Manage heart failure with ACE inhibitors and suitable diuretics

Question 31

TS cause and always with?

Answer 31

caused by rheumatic fever and accompanied by mitral valve disease.

Question 32

prophylaxis in valvular heart disease? Who wlse gets this?

Answer 32

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.

Question 33

Signs of cyanotic heart disease

Answer 33

Clubbing, cyanosis, crouching posture, crying, rapid breathing and heart rate, delayed development.

Question 34

Sx of PDA

Answer 34

raised WOB, failure to thrive, CHF, machinery murmur, cardiomegaly, tachycardia, cyanosis,

Question 35

Mx of PDA

Answer 35

NSAIDs

if fail - percutaneous surgery

Question 36

When would you not treat PDA

Answer 36

If great vessels are transposed, this needs to remain patent; prostaglandins given until corrective surgery has been provided.

Question 37

What happens in coarctation of the aorta?

Answer 37

Aorta narrows around the ductus arteriosus.

Causes left ventricular hypertrophy to compensate.

Question 38

What is marfans ? phenotype?

Answer 38

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

Question 39

Marfans complications

Answer 39

Mitral valve prolapse, aneurysms, osteoarthritis, GORD, aortic dissection, pneumothorax,

Question 40

Mx of Marfans

Answer 40

No cure.
Requires regular cardio check ups.

Beta blockers (metoprolol) and losartan