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Y6 Senior Med COPY LaLz > Cardiac murmurs > Flashcards

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
Q

what are causes of MR

A

Chronic:

  • mitral valve prolapse
  • RHD
  • calcification

Acute

  • IE
  • IHD
26
Q

ix of MR (same for all)

A

ECG
Bloods

CXR

Echo

Coronary angiogram

27
Q

how do you mx MR

A

MDT approach

Conservative: RF modification, regular followup

Medical: aim to reduce afterload with ACEi, beta blocker or diuretic

Surgical: valve replacement or repair

28
Q

explain how AR occurs

A

backflow of blood through aortic valve during diastole

29
Q

Causes of AR

A

chronic:
bicuspid aortic valve
RHD
CTD

Acute:
IE
Aortic dissection (stanford A)

30
Q

what does AR sound like

A

early diastolic murmur
loudest at lower left sternal edge

31
Q

what is an austin flint murmur, what is it caused by

A

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
Q

what is pulse pressure like in AS vs AR

A

AS: narrow
AR: wide e.g. 180/50

33
Q

what is the pulse like in AR

A

waterhammer (collapsing)

34
Q

what is the apex beat like in AR

A

displaced and thrusting (because LV becomes hypertrophied and dilated)

35
Q

mx of AR

A

same as MR

MDT approach

Conservative = lifestyle mod

Medical = aim to reduce afterload (ACEi, BB, diuretic)

Surgical = valve replacement

36
Q

what condition is MR and MS associated with

A

AF – because MR and MS cause left atrial enlargement, which increases risk of AF

37
Q

what facial feature occurs with MS

A

malar flush

38
Q

what does MS murmur sound like

A

mid diastolic murmur

39
Q

whee aand how is MS best heard

A

in left lateral position
with bell
at end expiration

40
Q

which murmur is associated with AF

A

Mitral regurgitation or mitral stenosis

41
Q

causes of MS

A

RHD > include benzylpen prophylaxis in your management

Y6 Senior Med COPY LaLz (29 decks)

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