Cardio - Murmurs Flashcards
What valve diseases can cause cardiac hypertrophy?
Aortic Stenosis
Mitral stenosis
What valve diseases can lead to cardiac dilatation?
Mitral regurgitation
Aortic Regurgitation
When would S3 be heard and what can indicate?
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
When would you hear S4?
A fourth heart sound would be heard directly before S1.
What causes S4?
Always abnormal and very rare
Stiff or hypertrophied ventricle.
It is caused by turbulent flow from the atria
Give some causes of mitral stenosis:
Infective endocarditis
Rheumatic fever
What valve disease would you expect in a mid diastolic low pitched rumbling murmur?
Mitral Stenosis
Give some other signs and symptoms of mitral stenosis:
Malar flush
Atrial fibrillation
Loud S1
Tapping apex beat
What valve disease would cause a high pitched, pan systolic murmur that radiates to the left axilla?
Mitral Regurgitation
List some causes of mitral regurgitation:
Marfans Ehler Danlos syndrome Ischaemic heart disease Rheumatic fever Infective endocarditis Idiopathic age related weakening
What heart condition can result from mitral regurgiation?
Congestive heart failure
What other signs may be seen with mitral regurgitation?
S3
Reduced ejection fraction
Radiates to the axilla
“whistling” murmur
What is the most common valve disease you will come acorss?
Aortic stenosis
What valve disease would cause an ejection systolic murmur which is high pitched and has a crescendo-decrescendo character?
Aortic stenosis
What other symptoms and signs may be seen in a patient with aortic stenosis?
Radiating murmur to the carotids
Slow rising pulse
Narrow pressure pule
Exertional Syncope
What are the main causes of aortic stenosis?
Rheumatic heart disease
idiopathic
Age related calcification
What valve disease would cause an early diastolic, soft murmur?
Aortic regurgitation
What is Corrigan’s pulse/ corrigans sign? What valve disease is this associated with?
This is a collapsing pulse and pulsations of the carotids. It is associated with aortic regurgitation (insufficiency)
What is an Austin flint murmur?
This is an early diastolic rumbling murmur best heard at the apex. Caused by aortic regurgitation
What are some causes of Aortic regurgitation?
Idiopathic
Age related weakness
Connective tissue diseases
What is a pro and con of mechanical heart valves?
Pro - they have a long lifespan of >/20 years
Con - require lifelong warfarin anti coagulation
What is the ideal INR for patients on warfarin?
2.5-3.5
What is the typical lifespan of a bio prosthetic valve?
Roughly 10 years.
What are the main risks of a mechanical heart valve?
Thrombus
Infective endocarditis
Haemolysis leading to haemolytic anaemia
Define TAVI:
Transcatheter Aortic Valve Implantation
When might a TAVI procedure be more appropriate?
Treatment for severe aortic stenosis - especially in high risk patients who would not be suitable for an open procedure
What % of patients who undergo valve replacements end up with infective endocarditis?
2.5%
What are the main causative organisms for infective endocarditis?
Staphylococcus Aureus
Streptococcus Viridans
Streptococcus
What are some other signs and symptoms of aortic regurgitation?
Wide pulse pressure Large volume collapsing pulse Capillary bed pulsations (Quinke's sign) Pistol shots over the arteries Head nodding in time with pulse
What is the deMusset sign?
This is when the head nods along in time with the patient’s pulse and is seen in aortic regurgitation
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?
Tricuspid regurgitation
What valve disease is often associated with carcinoid syndrome and may be congenital?
Pulmonary stenosis
Tricuspid stenosis is also seen more rarely in carcinoid syndrome
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?
Pulmonary stenosis
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?
Atrial septal defect
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?
Ventricular septal defect
If you see a child in the “squatting position” trying to help themselves breath, what congenital heart problem may they suffer from?
Tetralogy of Fallot
What is Erb’s point?
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.
What valve disease would you expect in a mid diastolic, rumbling murmur best heard at the left lower sternal edge, made louder by inspiration?
Tricuspid stenosis
What valve disease would cause a decrescendo, diastolic murmur?
Pulmonary regurgitation
Very hard to distinguish between aortic regurgitation but usually asymptomatic patient
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?
Patent ductus arteriosis
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?
Coartication of the aorta
What finding during a paediatric baby check is suggestive of aortic coartication?
Radiofemoral delay with a difference in pre and post ductal saturation
What is the cut off aortic gradient for aortic valve stenosis valve repair?
40mmHg
In patients with critical aortic stenosis who are not fit for an valve replacement, what is the next most suitable management option?
Aortic balloon valvuloplasty
What investigation is often done in patients with aortic stenosis before a valve replacement and why?
Coronary angiogram
To look for co-existing cardiovascular disease
In pulmonary hypertension, what would be heard on auscultation?
Loud Second heart sound
What is the most common cause of mitral stenosis?
Rheumatic fever
