Cardiac signs and Murmurs

Question 1

What murmur is indicated by malar flush?

Answer 1

mitral stenosis

Question 2

What does a heave represent?

Answer 2

right ventricular enlargement

Question 3

When auscultating for a murmur what must you not forget to do at the same time and why?

Answer 3

feel the carotid or the radial pulse at the same time to assess whether the murmur is systolic or diastolic.

Question 4

is the JVP raised in aortic stenosis?

Answer 4

no

Question 5

what murmur would you hear in aortic stenosis?

Answer 5

ejection systolic murmur

Question 6

what are some causes of aortic stenosis?

Answer 6

degenerative calcific aortic stenosis (of a normal valve)
congenital bicuspid valve
rheumatic heart disease

Question 7

what happens to the ventricle in aortic stenosis?

Answer 7

Left ventricular hypertrophy due to pressure overload

Question 8

name 4 causes of pressure overload to the left ventricle

Answer 8

aortic stenosis
HTN
coarctation of the aorta
hypertrophic cardiomyopathy (with LV outflow obstruction)

Question 9

are symptoms a good guide to severity in aortic stenosis?

Answer 9

yes

Question 10

what symptoms might you get in aortic stenosis?

Answer 10

exercise induced syncope, angina and breathlessness

Question 11

what is the definitive treatment for aortic stenosis?

Answer 11

valve replacement

Question 12

for those unfit for cardiopulmonary bypass what treatment can you offer them in aortic stenosis?

Answer 12

Transcatheter aortic valve insertion (TAVI)- valvuloplasty of stenosis and new valve inserted via the femoral artery.

Question 13

what is the difference between aortic stenosis and aortic sclerosis?

Answer 13

aortic sclerosis is thickening of the valve leaflets- there is no radiation of the murmur
aortic stenosis is narrowing of the valve- the murmur radiates.

Question 14

what is the pulse like in aortic stenosis?

Answer 14

slow rising pulse, low volume pulse and low pulse pressure

Question 15

what are some causes of mitral regurgitation?

split the causes into leaflet, papillary muscle and chordae and annular dilatation

Answer 15

leaflet: congenital, endocarditis, degenerative
papillary muscle and chordae: MV prolapse, ACS, Marfans
annular dilation: cardiomyopathy, ischaemic heart disease with HF (the valve is stretched and therefore doesn’t close properly)

Question 16

is the apex beat displaced in mitral regurgitation?

Answer 16

yes due to volume overload

Question 17

what sort of murmur do you hear in mitral regorge and where does it radiate to?

Answer 17

pansystolic murmur radiating to the axilla

Question 18

how can you assess the severity of mitral regurgitation?

Answer 18

by how much the apex beat is displaced

Question 19

how would you treat mild-mod mitral regurgitation?

Answer 19

medical treatment with ACEi, diuretics +/- anticoagulants in order to reduce after load

Question 20

how would you treat severe mitral regurgitation?

Answer 20

valve replacement

Question 21

where does the murmur in aortic stenosis radiate to?

Answer 21

the ejection systolic murmur radiates to the carotids

Question 22

describe the apex beat in mitral stenosis

Answer 22

it is not displaced

it has a tapping character

Question 23

why is the apex beat tapping in mitral stenosis?

Answer 23

high atrial pressures keep the valve open until it snaps shut

Question 24

which valvular problem has the highest thrombotic risk?

Answer 24

mitral stenosis

Question 25

how does mitral stenosis lead to right HF? (do you know a flow diagram?)

Answer 25

mitral stenosis-->high LA pressure-->pulmonary venous HTN-->pulmonary artery HTN-->RV hypertrophy--> Tricuspid regurgitation--> R HF

Question 26

what is the management for mild mitral stenosis?

Answer 26

medical management e.g anticoagulants, diuretics, rate control of AF

Question 27

which valvular problem is AF also common?

Answer 27

Mitral stenosis

Question 28

describe the management of moderate mitral stenosis?

Answer 28

trans-septal valvuloplasty | valvular replacement

Question 29

describe the management of severe mitral stenosis

Answer 29

valve replacement

Question 30

what are some causes of aortic regurgitation?

Answer 30

``` Rheumatic heart disease Endocarditis Ankylosing spondylitis Luetic heard disease (syphilis) Marfan's ```

Question 31

is the apex displaced in aortic regurgitation?

Answer 31

yes due to volume overload leading left ventricular dilation

Question 32

what does the murmur for aortic regurgitation sound like?

Answer 32

lub tarrrrrr

Question 33

what are the possible compilation of a valve replacement?

Answer 33

``` Paravalvular leak Obstruction by thrombus Subactute bacterial endocarditis Haemolysis due to turbulence valve failure ```

Question 34

what can happen to the blood pressure with severe aortic stenosis?

Answer 34

in severe disease there can be a narrow pulse pressure

Question 35

what sort of symptoms would someone with aortic stenosis present with?

Answer 35

syncope, chest pain or SOB

Question 36

what are the clinical signs of aortic stenosis?

Answer 36

slow rising low volume pulse, narrow pulse pressure, a thrill in the aortic area and an ejection systolic murmur

Question 37

what are some complications of aortic stenosis?

Answer 37

``` endocarditis left ventricular dysfunction conduction problems (acute or chronic) ```