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Cardiology Clinical Skills > Auscultation of the heart > Flashcards

Auscultation of the heart Flashcards

Heart sounds and murmurs

1
Q

Describe the 1st heart sound

A

Mitral and tricuspid valves closing. Normal

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2
Q

Causes of a loud 1st heart sound

A

Hyperdynamic blood flow, moderate mitral stenosis

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3
Q

Describe 2nd heart sound

A

Aortic and pulmanory valves closing. Normal

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4
Q

Causes of a soft 1st heart sound

A

Obestity, emphysema, heart failure

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5
Q

Why does physiological splitting of the 2nd heart sound occur?

A

On inspiration the intrathoracic pressure decreases which will increase the venous return of the heart. This will increase the volume in the right ventricle and increase the ejection time. The pulmanory valve will shut after the aortic valve causing the splitting

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6
Q

Describe 3rd heart sound

A

Early diastolic low frequency filling sound. Immediately after the 2nd heart sound. Pathological or normal

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7
Q

Where is the 3rd heart sound best heard?

A

Apex beat with bell

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8
Q

Why does 3rd heart sound happen?

A

Decceleration and acceleration of blood that is passively filling into the ventricles

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9
Q

Causes of 3rd heart sound

A

Left ventricular dysfunction, heart failure

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10
Q

Descibe the 4th heart sound

A

Late diastolic low frequency filing sound. Immediately before the 1st. Pathological

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11
Q

Where is the 4th heart sound best heard?

A

Apex beat with bell

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12
Q

Causes of 4th heart sound

A

Hypertension, aortic stenosis, LVH, myocardial ischaemia

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13
Q

Why does 4th sound occur?

A

Filling of blood into a non cmplaince or stiff ventricle

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14
Q

How must murmurs be desribed?

A

Intensity, character, timing, location, radiation

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15
Q

Describe an innocent murmur

A

Soft, mid diastolic murmur

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16
Q

Where is innocent murmur heard?

A

Pulmanory area

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17
Q

Does innocent murmur radiate?

A

Localised, no radiation

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18
Q

What causes innocent murmur?

A

Hyperdynamic blood (pregnancy, thing, anaemia, young, fever, thyrotoxicosis), NORMAL

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19
Q

Why do innocent murmurs occur?

A

Turbulence of blood in right ventricular outflow tract

20
Q

Mitral regurgitation occurs when?

A

Systole

21
Q

Aortic regurgitation occurs when?

A

Diastole

22
Q

Mitral stenosis occurs when?

A

Diastole

23
Q

Aortic stenosis occurs when?

A

Systole

24
Q

Describe the murmur heard in aortic stenosis

A

Ejection systolic murmur that radiates to the carotids

25
Q

What is the apex like in aortic stenosis?

A

Forceful and displaces

26
Q

What are the assosiated symptoms of aortic stenosis

A

Breathlessness, syncope, chest pain

27
Q

What ECG changes may be seen in a patient with aortic stenosis?

A

Left axis deviation due to LVH. Causes chest pain as well due to mismathc between supply and demand

28
Q

What would a pressure probe graph look like with aortic stenosis?

A

High peak pressure before the valve comapred to after

29
Q

How to treat aortic stenosis?

A

Valve replacement, balloon therapy

30
Q

Describe a mitral regurgitation murmur

A

Pansystolic murmur that radiates to the axilla

31
Q

Apex beat in mitra regurgitation

A

Displaced

32
Q

Causes of mitral regurgitation

A

Rheumatic fever, prolapse, Chordiae or papilla muscle rupture, endocarditis, myxomatous

33
Q

Treatment of mitral regurgitation

A

ACEI, diuretics, Surgical repair and replacement

34
Q

Assosiated symptoms of mitral regurgitation

A

Breathlessness, fatigue, peripheral oedema

35
Q

Describe a mitral stenosis murmur

A

Mid diastolic rumbling murmur. Localised in apex

36
Q

Apex of mitral stenosis

A

Tapping apex

37
Q

Assosiated symptoms of mitral stenosis

A

Malar flush, breathlessness, fatigue, palpitations, AF!

38
Q

What could the Xray look like in a patietn with mitral stenosis?

A

Straight left heart border

39
Q

Causes of mitral stenosis

A

Rheumatic, rarely congenital

40
Q

Treatment of mitral stenosis

A

Diuretics, treat the AF, Surgery, ballon dilation

41
Q

What two heart valve defects may lead to cardiomegaly?

A

Aortic and mitral regurgitation

42
Q

Describe aortic reguritation

A

Early diastolic murmur. Localised to left sternal edge

43
Q

Apex in aortic regurgitation

A

Displaced

44
Q

Causes of aortic regurgitationn

A

Endocarditis, connective tissue diseases, rheumatic, Marfans, aortic dissection

45
Q

Assosiated symptoms and signs of aortic regurgitation

A

Breathless, collapsing pulse, pulse pulse pressure

46
Q

Treatment of aortic regurgitation

A

ACEI, Surgery

Cardiology Clinical Skills (1 decks)

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