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T1 - importance > all heart sounds and murmurs > Flashcards

all heart sounds and murmurs Flashcards

1
Q

cause of heart sounds in general

A

turbulent blood flowtensing of cardiac structuresvalve closure

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2
Q

cause of S1 heart sound

A

AV (tricuspid and mitral) valve closure

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3
Q

what phase of cardiac cycle is S1

A

start of systole - isovolumic contraction

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4
Q

phases of the cardiac cycle

A

isovolumic contraction - period between which AV valves shut, SL valves open; ventricles contracting in a closed circuit
rapid ejection - opening of SL valves; c wave in JVP
reduced ejection - slowing of ejection ultimately causing closure of SL valves (aortic and pulmonary trunk pressures >ventricular pressure)isovolumic relaxation - relaxation of ventricles when both AV and SL valves are shut; V wave in JVPrapid ventricular filling - AV valves open causing rapid filling; y descent in jvpdiastasis - as filling of ventricles nears ~80%atrial systole - atria contract to top of the ventricles with last amount of blood; a wave in jvp

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5
Q

cause of S2 heart sound

A

SL (pulmonary and aortic) valve closure

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6
Q

what phase of cardiac cycle is S2

A

end of systole/beginning of diastole - isovolumic relaxation

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7
Q

cause of S3 heart sound

A

volume overload
tensioning of chordae tendinae at the end of rapid ventricular filling
sudden deceleration of blood against LV

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8
Q

cause of S4 heart sound

A

pressure overload

reflection of atrial wave against a poorly compliant ventricle (thickened or stiff)

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9
Q

pathologies where S4 is seen

A

LV hypertrophy secondary to HTN
aortic stenosis,acute MR
IHD, age +++
angina, MI sometimes - only thing seen acutely

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10
Q

pathologies where S3 is seen

A

normal in young people and athletes
in older people - congestive heart failure
physiological - thyrotoxicosis, pregnancy

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11
Q

symptoms of MS

A

dyspnea, orthopnea, PND - increased left atrial pressure
hemoptysis - ruptured bronchial veins
ascites, edema, fatigue - pulmonary HTN, decrease CO

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12
Q

signs of MS

A

mitral facies

peripheral cyanosis

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13
Q

pulse of MS

A

normal or reduce in volume - reduced CO

AF may be caused if left atrial enlargement

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14
Q

JVP in MS

A

normal height
prominent a wave if pulmonary HTN present
loss of a wave if AF

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15
Q

palpation in MS

A

tapping apex beat
RV heave
palpable P2

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16
Q

auscultation in MS

A

T/C - mid diastolic low pitched rumbling diastolic murmur
R - nil
loud S1 - valve cusps remain wide open at onset of systole
loud or palpable P2 if pulmonary HTN
opening snap - high LA pressure forces valve open

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17
Q

accentuation manoeuvres in MS

A

exercise

left lateral position

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18
Q

causes of MS

A

RHD

congenital parachute valve

19
Q

MR symptoms

A

dyspnea - increased LA pressure

fatigue - decreased CO

20
Q

MR signs

A

tachypnea

21
Q

MR pulse

A

normal or sharp upstroke due to rapid ventricular decompression
AF relatively common

22
Q

JVP in MR

A

n/a

23
Q

palpation in MR

A

displaced, diffuse and hyperdynamic apex beat
pansytolic thrill occasionally present at apex
parasternal heave due to LA enlargement behind the RV

24
Q

auscultation in MR

A

T/C - pansytolic murmur maximal at apex and usually radiating towards axilla
soft or absent S1-
LV S3 due to rapid LV filling in early diastole

25
Q

MR accentuation manoeuvres

A

valsalva - longer and louder

26
Q

causes of MR

A

mitral valve prolapse
degeneration associated with age
RHD
papillary muscle dysfunction due to LV failure or ischemia
cardiomyopathy - hypertrophic, dilated or restrictive
CT diseases
congenital

27
Q

AR symptoms

A

occurs in late stage of disease
exertional dyspnea, fatigue, exertional angina - decreased CO
palpitations - hyperdynamic circulation

28
Q

AR signs

A

none specifically but
marfanoid features
Ankolysing spondylitis or other seronegative arthropathies

29
Q

AR pulse and BP

A

collapsing pulse ‘water hammer’ - most obvious if raising patient’s arm while feeling radial pulse
wide pulse pressure - DBP very low as leaking back constantly, SBP normal
bisfiriens pulse - severe AR - venturi effect - rapid ejection and brief in drawing of aortic wall leading to a diminution of the pulse followed by rebound increase

30
Q

AR JVP/neck

A

prominent carotid pulsations

31
Q

AR palpation

A

displaced and dyskinetic apex beat

diastolic thrill may be felt at LSE if sitting up and exhaling

32
Q

AR auscultation

A

T/C - early diastolic, decrescendo quality, high pitched. may extend for variable time into diastole
loudest at 3/4 ICS
soft A2 component
systolic ejection murmur usually also present - aortic stenosis or turbulent flow across normal diameter aortic valve

33
Q

AR accentuation manouvres

A

expiration and leaning forward

34
Q

acute AR causes

A

valvular - IE

aortic root - marfan’s syndrome - aortic dissection

35
Q

chronic AR causes

A 
valvular RHD (rarely the only murmur if so)
congenital (bicuspid valve, VSD)
seronegative arthropathy esp ankolysing spondylitis
aoritc root dilation
marfan's
aortitis
rheumatoid arthritis
teritary syphilis
dissecting aneurysm
36
Q

differentiate acute AR to chronic AR

A

acute - no collapsing pulse (BP is low) and diastolic murmur is short

37
Q

AS symptoms

A

exertional chest pain (50% no CAD)

exertional dyspnea and exertional syncope

38
Q

AS signs

A

usually nothing remarkable

39
Q

AS pulse

A 
plateau pulse (anacrotic)
OR late peaking and low volume (tardus et parvus)
40
Q

AS JVP

A

n/a

41
Q

AS palpation

A

hyperdynamic apex beat
may be slightly displaced
systolic thrill at base of heart (in aortic area)

42
Q

AS auscultation

A

T/C - harsh (mid)systolic ejection murmur, crescendo - decrescendo
R - maximal over aortic area and extending into carotids, may extend widely over precordium and extend to apex
narrowly split or reversed S2 - delayed LV ejection

43
Q

AS accentuation manouvres

A

sitting up and in full expiration

note - associated aortic regurg is common

44
Q

AS causes

A

degenerative calcific aortic stenosis - elderly
calcific in younger patients - congenital bicuspid valve
rheumatic

T1 - importance (9 decks)

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