Cardiac murmurs Flashcards

1
Q

Explain what ventricular diastole is

A

Ventricle is RELAXED as blood flows into them from the atria, through the atrioventricular valves

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2
Q

explain what ventricular systole is

A

Ventricle CONTRACTS and pushes blood out through semilunar valves, shutting AV valves

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3
Q

Explain what S1 means

A

S1 = shutting of atrioventricular valves at end of diastole / beginning of systole

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4
Q

Explain what S2 means

A

S2 = shuttiing of semilunar valves at the end of systole, when the blood has been emptied from the ventricles

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5
Q

So what is the time period between S1 and S2

A

systole

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6
Q

what is the time period between S2 and S1

A

diastole

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7
Q

So when do the systolic murmurs happen, and what is the single best word to describe them

A

between S1 and S2
LOUD

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8
Q

So when do the diastolic murmurs happen

A

between S2 and S1

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9
Q

what are the systolic murmurs

A
aortic stenosis (ejection systolic: crescendo-decrescendo) 
mitral regurg (pansystolic)
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10
Q

what are diastolic murmurs

A
aortic regurg (early diastolic) 
mitral stenosis (mid-diastolic)
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11
Q

what are causes of aortic stenosis

A

Calcification (age related)
bicuspid aortic valve
Rheumatic fever

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12
Q

symptoms of AS

A

SAD

  • syncope
  • angiina
  • dyspnoea
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13
Q

where is AS loudest

A

2nd ICS at sternal edge

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14
Q

what does AS sound lije

A

ejection systolic: crescendo-decrescendo during systole

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15
Q

when is AS loudest (time + maneuvr)

A

on EXPIIRATION
pt leaning FORWARD

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16
Q

where does AS radiate to

A

to CAROTIDS

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17
Q

what is apex beat like in AS

A

forceful, non displaced

18
Q

what is pulse like in AS

A

slow rising
narrow pulse pressure

19
Q

ix for AS

A

EBCEC

ECG (LVH, arrythhmia)

Bloods (FBC for anaemia, UE, lipids, glucose, BNP for HF)

CXR (Calcifications, LVH, pulmonary oedema)

Echo (to confirm and grade severity)

Coronary angiogram

20
Q

mx of AS

A

OVERALL: MDT approach (cardiologist, GP, specialist nurses – if necessary cardiothoracic surgeon, dietician, OT or physio)

Conservative: lifestyle modification (diet, exercise)

Medical: calculate QRisk (statins, antiplatelets), manage comorb HTN, diabetes etc

Surgical: valve replacement (biologic/artificial) or TAVI(transcatheter AV implantation)

21
Q

main ddx of AS

A

Aortic sclerosis

= ejection systolic murmur, but does NOT radiate to carotids

22
Q

what does mitral regurg sound like

A

pansystolic murmur

23
Q

where is MR loudest and how (maneuvres=

A

loudest on expiration in left lateral position over the apex

24
Q

where does MR radiate to

A

MR radiates to axill

25
what are causes of MR
Chronic: - mitral valve prolapse - RHD - calcification Acute - IE - IHD
26
ix of MR (same for all)
ECG Bloods CXR Echo Coronary angiogram
27
how do you mx MR
MDT approach Conservative: RF modification, regular followup Medical: aim to reduce afterload with ACEi, beta blocker or diuretic Surgical: valve replacement or repair
28
explain how AR occurs
backflow of blood through aortic valve during diastole
29
Causes of AR
chronic: bicuspid aortic valve RHD CTD Acute: IE Aortic dissection (stanford A)
30
what does AR sound like
early diastolic murmur loudest at lower left sternal edge
31
what is an austin flint murmur, what is it caused by
Austin Flint: low pitched rumbling mid-diastolic murmur heard best at the apex. Caused by the regurgitated blood through the aortic valve mixing with blood from the left atrium, during atrial contraction. Sign of severe aortic regurgitation.
32
what is pulse pressure like in AS vs AR
AS: narrow AR: wide e.g. 180/50
33
what is the pulse like in AR
waterhammer (collapsing)
34
what is the apex beat like in AR
displaced and thrusting (because LV becomes hypertrophied and dilated)
35
mx of AR
same as MR MDT approach Conservative = lifestyle mod Medical = aim to reduce afterload (ACEi, BB, diuretic) Surgical = valve replacement
36
what condition is MR and MS associated with
AF -- because MR and MS cause left atrial enlargement, which increases risk of AF
37
what facial feature occurs with MS
malar flush
38
what does MS murmur sound like
mid diastolic murmur
39
whee aand how is MS best heard
in left lateral position with bell at end expiration
40
which murmur is associated with AF
Mitral regurgitation or mitral stenosis
41
causes of MS
RHD \> include benzylpen prophylaxis in your management