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4th Year Gen Med > Cardio - Murmurs > Flashcards

Cardio - Murmurs Flashcards

1
Q

What valve diseases can cause cardiac hypertrophy?

A

Aortic Stenosis

Mitral stenosis

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2
Q

What valve diseases can lead to cardiac dilatation?

A

Mitral regurgitation

Aortic Regurgitation

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3
Q

When would S3 be heard and what can indicate?

A

S3 can be heard roughly 0.1s after S2 and in young patients it can be physiologically normal.
In elderly patients it may be a sign of heart failure

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4
Q

When would you hear S4?

A

A fourth heart sound would be heard directly before S1.

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5
Q

What causes S4?

A

Always abnormal and very rare
Stiff or hypertrophied ventricle.
It is caused by turbulent flow from the atria

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6
Q

Give some causes of mitral stenosis:

A

Infective endocarditis

Rheumatic fever

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7
Q

What valve disease would you expect in a mid diastolic low pitched rumbling murmur?

A

Mitral Stenosis

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8
Q

Give some other signs and symptoms of mitral stenosis:

A

Malar flush
Atrial fibrillation
Loud S1
Tapping apex beat

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9
Q

What valve disease would cause a high pitched, pan systolic murmur that radiates to the left axilla?

A

Mitral Regurgitation

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10
Q

List some causes of mitral regurgitation:

A 
Marfans
Ehler Danlos syndrome
Ischaemic heart disease
Rheumatic fever
Infective endocarditis
Idiopathic age related weakening
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11
Q

What heart condition can result from mitral regurgiation?

A

Congestive heart failure

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12
Q

What other signs may be seen with mitral regurgitation?

A

S3
Reduced ejection fraction
Radiates to the axilla
“whistling” murmur

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13
Q

What is the most common valve disease you will come acorss?

A

Aortic stenosis

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14
Q

What valve disease would cause an ejection systolic murmur which is high pitched and has a crescendo-decrescendo character?

A

Aortic stenosis

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15
Q

What other symptoms and signs may be seen in a patient with aortic stenosis?

A

Radiating murmur to the carotids
Slow rising pulse
Narrow pressure pule
Exertional Syncope

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16
Q

What are the main causes of aortic stenosis?

A

Rheumatic heart disease
idiopathic
Age related calcification

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17
Q

What valve disease would cause an early diastolic, soft murmur?

A

Aortic regurgitation

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18
Q

What is Corrigan’s pulse/ corrigans sign? What valve disease is this associated with?

A

This is a collapsing pulse and pulsations of the carotids. It is associated with aortic regurgitation (insufficiency)

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19
Q

What is an Austin flint murmur?

A

This is an early diastolic rumbling murmur best heard at the apex. Caused by aortic regurgitation

20
Q

What are some causes of Aortic regurgitation?

A

Idiopathic
Age related weakness
Connective tissue diseases

21
Q

What is a pro and con of mechanical heart valves?

A

Pro - they have a long lifespan of >/20 years

Con - require lifelong warfarin anti coagulation

22
Q

What is the ideal INR for patients on warfarin?

A

2.5-3.5

23
Q

What is the typical lifespan of a bio prosthetic valve?

A

Roughly 10 years.

24
Q

What are the main risks of a mechanical heart valve?

A

Thrombus
Infective endocarditis
Haemolysis leading to haemolytic anaemia

25
Q

Define TAVI:

A

Transcatheter Aortic Valve Implantation

26
Q

When might a TAVI procedure be more appropriate?

A

Treatment for severe aortic stenosis - especially in high risk patients who would not be suitable for an open procedure

27
Q

What % of patients who undergo valve replacements end up with infective endocarditis?

A

2.5%

28
Q

What are the main causative organisms for infective endocarditis?

A

Staphylococcus Aureus
Streptococcus Viridans
Streptococcus

29
Q

What are some other signs and symptoms of aortic regurgitation?

A 
Wide pulse pressure
Large volume collapsing pulse
Capillary bed pulsations (Quinke's sign)
Pistol shots over the arteries
Head nodding in time with pulse
30
Q

What is the deMusset sign?

A

This is when the head nods along in time with the patient’s pulse and is seen in aortic regurgitation

31
Q

What type of valve disease would you expect in a blowing pan-systolic murmur best heard at the left lower sternal edge during inspiration, accompanied with a raised JVP?

A

Tricuspid regurgitation

32
Q

What valve disease is often associated with carcinoid syndrome and may be congenital?

A

Pulmonary stenosis

Tricuspid stenosis is also seen more rarely in carcinoid syndrome

33
Q

What valve disease would you expect in a patient with a harsh, mid-systolic ejection murmur best heard in the left upper sternal border, 2nd intercostal space, accompanied by a 4th heart sound, thrill and a right ventricular heave?

A

Pulmonary stenosis

34
Q

A patient presents with left parasternal heave, wide fixed splitting of the 2nd heart sound and a mid systolic murmur best heard at the left sternal edge – what is the most likely cause?

A

Atrial septal defect

35
Q

Patient presents with a loud/harsh pan-systolic murmur, cyanosis and clubbing, along with symptoms of dyspnoea chest pain and syncope? What is the most likely diagnosis?

A

Ventricular septal defect

36
Q

If you see a child in the “squatting position” trying to help themselves breath, what congenital heart problem may they suffer from?

A

Tetralogy of Fallot

37
Q

What is Erb’s point?

A

This is the best place for listening to heart sounds S1 and S2. It is located in the 3rd intercostal space at the left sternal border.

38
Q

What valve disease would you expect in a mid diastolic, rumbling murmur best heard at the left lower sternal edge, made louder by inspiration?

A

Tricuspid stenosis

39
Q

What valve disease would cause a decrescendo, diastolic murmur?

A

Pulmonary regurgitation

Very hard to distinguish between aortic regurgitation but usually asymptomatic patient

40
Q

What heart condition will lead to a continuous machinery murmur best heard below the left clavicle in the first intercostal space, and is often accompanied with a thrill?

A

Patent ductus arteriosis

41
Q

What heart condition will cause a mid to late systolic murmur best heard over the upper precordium or the back which may be accompanied by vascular bruits?

A

Coartication of the aorta

42
Q

What finding during a paediatric baby check is suggestive of aortic coartication?

A

Radiofemoral delay with a difference in pre and post ductal saturation

43
Q

What is the cut off aortic gradient for aortic valve stenosis valve repair?

A

40mmHg

44
Q

In patients with critical aortic stenosis who are not fit for an valve replacement, what is the next most suitable management option?

A

Aortic balloon valvuloplasty

45
Q

What investigation is often done in patients with aortic stenosis before a valve replacement and why?

A

Coronary angiogram

To look for co-existing cardiovascular disease

46
Q

In pulmonary hypertension, what would be heard on auscultation?

A

Loud Second heart sound

47
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever

4th Year Gen Med (10 decks)

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