Cardiology 8 - Murmurs Flashcards
what causes S1 and S2?
S1 - closing of atrioventricular valves (mitral, tricuspid) START OF SYSTOLE
S2 - closing of semilunar valves (aortic, pulmonary)
END OF SYSTOLE
why may you hear a third heart sound, S3?
0.1 secs after S2
in young = healthy twanging of chordae tendonae from rapid ventricular filling
in old >50 = may indicate heart failure
what causes a fourth heart sound, S4?
directly before S1
indicates hypertrophic ventricle, always abnormal
turbulent flow from non-compliant ventricle as atria contract
pitches of sounds
bell =
diaphragm =
bell = low pitched diaphragma = high pitched sounds heard better
listening locations for valves
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
Erb’s point = best location for S1+S2
third ICS on left sternal border
special manoeuvres x 2
lean to left hand side - better hearing MS
lean forward on held expiration = AR
6 steps in assessing // describing a murmur
Site loudest Character (soft/blowing/crescendo etc) Radiation Intensity (grade 3 = easy to hear) Pitch (high, low, grumbling) Timing (sys or dia)
recall a script for describing a murmur
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…
which valve disease causes hypertrophic changes in the previous chamber?
stenosis
which valve disease causes dilatation in the previous chamber?
regurgitation
2 x causes mitral stenosis
rheumatic heart disease
infective endocarditis
6 examination findings with mitral stenosis (3 describe the murmur)
1 associated finding for bonus points
mid-diastolic murmur low pitched rumbling loud S1 tapping apex beat malar flush (some may have AF)
give 5 causes of mitral regurgitation
weakened by ageing ischaemic heart disease infective endocarditis rheumatic heart disease connective tissue disorders (Marfan, Ehlers Danlos)
5 examination findings in mitral regurgitation (4 describe the murmur)
pan-systolic murmur high pitched whistling radiates to left axilla third heart sound (once have developed left heart failure)
2 x causes of aortic stenosis
age-related calcification
rheumatic heart disease
triad for aortic stenosis
angina
dyspnoea
(exertional)syncope
6 examination findings in aortic stenosis (3 describe the murmur)
ejection systolic murmur high pitched crescendo-decrescendo radiates to carotids slow-rising pulse narrow pulse pressure
causes x 2 of aortic regurgitation
weakening with age
connective tissue disorders
4 examination findings with aortic regurgitation (2 of the murmur)
early diastolic murmur
soft
collapsing pulse
wide pulse pressure
describe Austin Flint murmur
apex early diastolic rumbling due to backflow over the mitral valve in regurgitation
