Cardiac - murmurs Flashcards
systolic murmurs (7)
Ejection:
- Aortic sclerosis (no radiation)
- Aortic stenosis
Pan:
- Mitral regurgitation
- Mitral prolapse
Other:
- Ventricular septal defect
- Hypertrophic cardiomyopathy (early)
- Innocent
Diastolic murmurs
Early:
- Aortic regurgitation
- Pulmonic regurgitation
(- LAD artery stenosis??)
Mid: - Mitral stenosis - Tricuspid stenosis - Atrial myxoma ( - Austin-flint and Carey-Coombs murmurs)
Continuous murmurs
PDA
Features of murmurs (5)
- Intensity
- Pitch
- Configuration (crescendo etc.)
- Location
- Timing
Murmur grading
1 - faintest 2 - faint but early identification 3 - moderately loud 4 - associated thrill 5 - not heard without stethoscope 6 - audible without stethoscope
Causes of Aortic stenosis:
Acquired - Calcification, rheumatic fever
Congenital - Bicuspid valve
Causes of Aortic regurgitation:
Acute:
- Infective endocarditis
- Type A aortic dissection
Chronic: Congenital - bicuspid aortic valve Rheumatic heart disease connective tissue disorders - marfans, Ehlers Danlos Autoimmune - RA, Ank Spond
Signs of A. Stenosis
ESM - Radiates to carotids - Loudest sitting forward, end expiration - Muffled A2 Slow rising pulse
Signs of A. Regurgitation
Corrigans - carotid pulsation De Mussets - head bobbing Quinckes - nail bed pulsation Traubes - pistol shot femorals Austin-flint murmur - MDM = severe AR Duroziezs - murmur over femoral artery with proximal compression EDM - sitting forward, end expiration Collapsing pulse
Rheumatic fever bacteria
Strep Pyogenes
Group A Beta-strep
Causes of M. Stenosis
Congenital
Prosthetic valve
Rheumatic fever
Signs of M. Stenosis
AF and palpitations
Malar flush (ortners syndrome - cardiovocal)
Tapping apex
MDM - Apex, radiates to axilla, graham steele murmur
Austin-flint murmur
A. regurgitation
Graham-Steele murmur
PR secondary to M. Stenosis
Causes of M. regurgitation
M. valve prolapse LV dilation - AR, AS, HTN annular calcification Post-MI - papillary dysfunction Rheumatic fever Connective tissue disorders
Signs of M. regurgitation
AF
left parasternal heave
Displaced apex
PSM - radiates to axilla
Causes of M. prolapse
primary - myxomatous degeneration
MI
Connective tissue disorders
Turners
Causes of T. regurgitation
RV dilation
Rheumatic fever
Infective endocarditis
carcinoid syndrome
Causes of T. stenosis
Rheumatic fever
Causes of P. regurgitation
Pulmonary HTN
Graham-steele murmur
Causes of P. stenosis
Congenital - turners, Fallots
Rheumatic fever
Carcinoid syndrome
Carcinoid syndrome
paraneoplastic syndrome secondary to carcinoid tumours due to endogenous secretion of seratonin and kallikrenin
Carcinoid tumours
neuro-endocrine tumours
