Cardiology - murmurs Flashcards
S1 heart sound
Mitral and tricuspid valve closure
Lub
S2 heart sound
Aortic and pulmonary valve closure
End of ventricular systole
Dub
Split-S1
S1 is heard as two adjacent sounds
Mitral and tricuspid valve closure offset
Split-S2
S2 is heard as two adjacent sounds
Closure of aortic and pulmonic valves offset
S3
Additional heart sound.
S3 produced during passive left ventricular filling when blood strikes a compliant left ventricle.
Kentucky
S4
This is an additional sound – occurs before S1
Results from a forceful atrial contraction during presystole that ejects blood into a hypertrophied ventricle which cannot expand further
Tennessee
Which of the following does not cause a systolic murmur?
Atrial septal defect Ventricular septal defect Hypertrophic obstructive cardiomyopathy (HOCM) Aortic regurgitation None of the above
Aortic regurgitation
Early-diastolic
Pan-systolic murmurs?
Regurgitation murmurs:
Tricuspid regurgitation
Mitral regurgitation
Ventricular Septal Defect (VSD)
Mid-systolic murmur?
Stenosis:
AS
Late-systolic murmur?
Valve prolapse
Early-diastolic murmurs?
Regurg:
AR
Pulmonary regurg
Mid-diastolic murmurs?
Stenosis:
MS
TS
You perform a cardiovascular examination on an elderly gentleman who reports episodes of collapsing and often wakes up short of breath at night. Upon auscultation you discover an ejection systolic murmur, which radiates to the carotids.
Aortic stenosis Aortic regurgitation Mitral regurgitation Tricuspid regurgitation Mitral stenosis
Aortic stenosis
AS symptoms and signs?
Symptoms: Collapse Worsening SOB(OE) Paroxysmal nocturnal dyspnoea Leg swelling
Signs: Crescendo decrescendo systolic murmur ESM Heaving apex beat Narrowed pulse pressure (eg.110/94) ECG - LVH evidence
A 53-year-old woman with Atrial Fibrillation is reviewed by her cardiologists. On inspection the patients cheeks appear quite flushed. Auscultation reveals a very loud S1 and a mid diastolic murmur.
Mitral stenosis Graham Steell Mitral regurgitation Aortic regurgitation Austin Flint
Mitral stenosis
Graham Steell?
Associated with pulmonary regurgitation
High-pitched early diastolic murmur
Best heard at the left sternal edge at full inspiration
Austin Flint?
Aortic Incompetence - caused by aortic regurg.
Due to noise of turbulent blood flow hitting the anterior leaflets of mitral valve
Mid-diastolic
Heart best at apex beat
Mitral stenosis?
Mid-diastolic murmur Opening snap! Often associated with AF and rheumatic fever Accentuated by patient lie on left Red cheeks
49-year-old women presents with 3 month history of increasing SOB on exertion. She has no chest pain, cough or ankle swelling. On examination: BP 158/61 and there are crackles at the bases of both lungs. On Auscultation you hear a diastolic decrescendo murmur loudest at the left sternal edge.
Aortic regurgitation Aortic stenosis Mitral regurgitation Mitral stenosis Tricuspid regurgitation
Aortic regurgitation
Aortic regurgitation?
Similar symptoms to HF: SOB, paroxysmal nocturnal dyspnoea, collapse
Wide pulse pressure
Watson’s water hammer pulse (aka Corrigan’s pulse/ collapsing pulse)
Quincke’s sign
De Musset’s sign
Becker’s sign
Causes of Mobitz Type I HB?
AV nodal disease usually due to drugs (beta-blockers) but can be due to inferior MI
Causes of Mobitz Type II HB?
His-Purkinje system disease usually due to tissue damage (infarction)
What does 3rd degree HB cause?
Leads to severe bradycardia, hypotension and haemodynamic instability
