Cardiac murmurs Flashcards
Explain what ventricular diastole is
Ventricle is RELAXED as blood flows into them from the atria, through the atrioventricular valves
explain what ventricular systole is
Ventricle CONTRACTS and pushes blood out through semilunar valves, shutting AV valves
Explain what S1 means
S1 = shutting of atrioventricular valves at end of diastole / beginning of systole
Explain what S2 means
S2 = shuttiing of semilunar valves at the end of systole, when the blood has been emptied from the ventricles
So what is the time period between S1 and S2
systole
what is the time period between S2 and S1
diastole
So when do the systolic murmurs happen, and what is the single best word to describe them
between S1 and S2
LOUD
So when do the diastolic murmurs happen
between S2 and S1
what are the systolic murmurs
aortic stenosis (ejection systolic: crescendo-decrescendo) mitral regurg (pansystolic)
what are diastolic murmurs
aortic regurg (early diastolic) mitral stenosis (mid-diastolic)
what are causes of aortic stenosis
Calcification (age related)
bicuspid aortic valve
Rheumatic fever
symptoms of AS
SAD
- syncope
- angiina
- dyspnoea
where is AS loudest
2nd ICS at sternal edge
what does AS sound lije
ejection systolic: crescendo-decrescendo during systole
when is AS loudest (time + maneuvr)
on EXPIIRATION
pt leaning FORWARD
where does AS radiate to
to CAROTIDS
what is apex beat like in AS
forceful, non displaced
what is pulse like in AS
slow rising
narrow pulse pressure
ix for AS
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
mx of AS
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)
main ddx of AS
Aortic sclerosis
= ejection systolic murmur, but does NOT radiate to carotids
what does mitral regurg sound like
pansystolic murmur
where is MR loudest and how (maneuvres=
loudest on expiration in left lateral position over the apex
where does MR radiate to
MR radiates to axill
what are causes of MR
Chronic:
- mitral valve prolapse
- RHD
- calcification
Acute
- IE
- IHD
ix of MR (same for all)
ECG
Bloods
CXR
Echo
Coronary angiogram
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
explain how AR occurs
backflow of blood through aortic valve during diastole
Causes of AR
chronic:
bicuspid aortic valve
RHD
CTD
Acute:
IE
Aortic dissection (stanford A)
what does AR sound like
early diastolic murmur
loudest at lower left sternal edge
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.
what is pulse pressure like in AS vs AR
AS: narrow
AR: wide e.g. 180/50
what is the pulse like in AR
waterhammer (collapsing)
what is the apex beat like in AR
displaced and thrusting (because LV becomes hypertrophied and dilated)
mx of AR
same as MR
MDT approach
Conservative = lifestyle mod
Medical = aim to reduce afterload (ACEi, BB, diuretic)
Surgical = valve replacement
what condition is MR and MS associated with
AF – because MR and MS cause left atrial enlargement, which increases risk of AF
what facial feature occurs with MS
malar flush
what does MS murmur sound like
mid diastolic murmur
whee aand how is MS best heard
in left lateral position
with bell
at end expiration
which murmur is associated with AF
Mitral regurgitation or mitral stenosis
causes of MS
RHD > include benzylpen prophylaxis in your management
