Cardiology 8 - Murmurs

Question 1

what causes S1 and S2?

Answer 1

S1 - closing of atrioventricular valves (mitral, tricuspid) START OF SYSTOLE
S2 - closing of semilunar valves (aortic, pulmonary)
END OF SYSTOLE

Question 2

why may you hear a third heart sound, S3?

Answer 2

0.1 secs after S2
in young = healthy twanging of chordae tendonae from rapid ventricular filling

in old >50 = may indicate heart failure

Question 3

what causes a fourth heart sound, S4?

Answer 3

directly before S1
indicates hypertrophic ventricle, always abnormal
turbulent flow from non-compliant ventricle as atria contract

Question 4

pitches of sounds
bell =
diaphragm =

Answer 4

bell = low pitched 
diaphragma = high pitched sounds heard better

Question 5

listening locations for valves

Answer 5

upper right sternal edge 2nd ICS = aortic

upper left sternal edge 2nd ICS = pulmonary

lower left sternal edge 5th ICS = tricuspid

5th ICS MCL = mitral

Question 6

Erb’s point = best location for S1+S2

Answer 6

third ICS on left sternal border

Question 7

special manoeuvres x 2

Answer 7

lean to left hand side - better hearing MS

lean forward on held expiration = AR

Question 8

6 steps in assessing // describing a murmur

Answer 8

Site loudest
Character (soft/blowing/crescendo etc)
Radiation
Intensity (grade 3 = easy to hear)
Pitch (high, low, grumbling)
Timing (sys or dia)

Question 9

recall a script for describing a murmur

Answer 9

This patient has a harsh / soft / blowing, Grade 3 systolic / diastolic murmur. It is heard loudest in the A/M/T/P area, with/out radiation to axilla / carotids. It is high / low pitched and has a cresc/descresc/c-d shape. This is suggestive of a diagnosis of…

Question 10

which valve disease causes hypertrophic changes in the previous chamber?

Answer 10

stenosis

Question 11

which valve disease causes dilatation in the previous chamber?

Answer 11

regurgitation

Question 12

2 x causes mitral stenosis

Answer 12

rheumatic heart disease

infective endocarditis

Question 13

6 examination findings with mitral stenosis (3 describe the murmur)

1 associated finding for bonus points

Answer 13

mid-diastolic murmur
low pitched
rumbling 
loud S1
tapping apex beat
malar flush
(some may have AF)

Question 14

give 5 causes of mitral regurgitation

Answer 14

weakened by ageing 
ischaemic heart disease
infective endocarditis
rheumatic heart disease
connective tissue disorders (Marfan, Ehlers Danlos)

Question 15

5 examination findings in mitral regurgitation (4 describe the murmur)

Answer 15

pan-systolic murmur
high pitched 
whistling
radiates to left axilla 
third heart sound (once have developed left heart failure)

Question 16

2 x causes of aortic stenosis

Answer 16

age-related calcification

rheumatic heart disease

Question 17

triad for aortic stenosis

Answer 17

angina
dyspnoea
(exertional)syncope

Question 18

6 examination findings in aortic stenosis (3 describe the murmur)

Answer 18

ejection systolic murmur 
high pitched 
crescendo-decrescendo
radiates to carotids 
slow-rising pulse 
narrow pulse pressure

Question 19

causes x 2 of aortic regurgitation

Answer 19

weakening with age

connective tissue disorders

Question 20

4 examination findings with aortic regurgitation (2 of the murmur)

Answer 20

early diastolic murmur
soft
collapsing pulse
wide pulse pressure

Question 21

describe Austin Flint murmur

Answer 21

apex early diastolic rumbling due to backflow over the mitral valve in regurgitation