Cardiac Murmurs

Question 1

Valvular defectes- are usually caused by 3 issues

Answer 1

1. Stenosis
2. Regurgitation
3. Prolapse
   NB- they will usually principally affect one part of the cardiac cycle. Diasytole/systole

Question 2

Aortic stenosis- Causes

Answer 2

• Congential heart defects
• Calcification of the heart valve
• Infection- rheumatic fever

Question 3

Aortic stenosis- Risk factors

Answer 3

• Age
• Uncontrolled HTN
• Diabetes
• Hypercholesterolaemia
• Infection
• CKD

Question 4

Heart mumurs 4 types

Answer 4

1. Ejection systolic
2. Pansystolic
3. Late systolic
4. Diastolic

Question 5

What is the cause of ejection systolic murmur and when does it occur

Answer 5

• Increased flow through normal valves- anaemia, fever, bradycardia, pregnancy, ASD
• Reduced through a stenotic valve- aortic stenosis, pulmonary stenosis
• Subvalvular obstruction- HOCM
• This is when you hear the murmur at the begining of systole

Question 6

Pansystolic murmur- What is the causes and when does it occur

Answer 6

• Mitral regurgitation
• Tricuspid regurgitation
• Ventricular septal defect- VSD (Important to rule out post MI)
• Leaking prosthesis
• Murmur continues through the whole of systole
• Hear S1 then murmur until you hear S2

Question 7

Late systolic murmur- causes

Answer 7

• Mitral valve prolapse
  *

Question 8

Diastolic murmur- causes

Answer 8

• Aortic regurgitation
• Mitral stenosis

Question 9

Aortic stenosis- symptoms

Answer 9

• Chest pain
• Pre-syncope or syncope during exertion- Key red flag (due to chance of critical progression)
• Breathlessness during exertion
• Fatigue during exertion
• Palpitations

Question 10

Aortic stenosis- Auscultation

Answer 10

• Ejection systolic murmur
• Loud at begning of systole but slowly gets quieter, both S1 and S2 will still be heard
• Must document if you hear second heart sound- critical stenosis
• Must auscultate carotids see if it radiates, ask pt to hold their breath

Question 11

Mitral regurgitation- causes

Answer 11

• Congentil heart defect
• Calcification of the valve
• Infection
• Cardiomyopathy
• MI
• Marfan’s syndrome- connective tissue disorders
• Endocarditis
• Trauma
• AF

Question 12

Mitral regurgitation- Risk factors

Answer 12

• Age
• Heart disease
• Family history

Question 13

Mitral regurgitation- Sx

Answer 13

• Breathlessness during exertion or laying down
• Fatigue palpitations- rapid fluttering
• Peripheral oedema

Question 14

Mitral regurgitation- Auscultation

Answer 14

• Pansystolic murmur
• High pitched soft blowing systolic murmur
• Can radiate to left auxila
• S1 may be absent (buried within the murmur)
• S2 usually present

Question 15

Ventricular septal defect

Answer 15

• Oxygenated blood is shunted from left to right via defects in the sputum between the ventricles
• A larger volume of blood than normal is pumped by the right ventricle which causes hypertrophy
• High blood volume through the pulmonary artery leads to pulmonary congestion and signs of HF
• Rare- in adults, usually correct at birth
• Can happen post MI- very high mortality rate, need to be aware of new pansystolic murmur

Question 16

Diastolic murmur

Answer 16

• Aortic regurgitation
• Early diastolic murmur, high pitched decrescendo
• Mitral stenosis- Loud S1, low pitched mid-diastolic murmur

Question 17

Documenting a murmur

Answer 17

• S1 + S2 + 0
• If there are added sounds
• Systolic vs diastolic (ejection systolic or pansystolic)
• Quality- harsh, soft, blowing
• Pitch- high low
• Location- Aortic, Pulmonary, Tricuspid, Mitral
• Suspected condition
• Grade of murmur