Cardiology - Valvular Heart Disease Flashcards
What causes S1 and S2 heart sounds?
S1
Closing of atrioventricular valves at start of systolic contraction
S2
Closing of pulmonary and aortic valves after systolic contraction
What causes a 3rd heart sound?
Can indicate heart failure as ventricles and chordae are stiff and weak
When is a third heart sound heard?
0.1 seconds after second heart sound
What does a fourth heart sound indicate?
Stiff or hypertrophic ventricle
Turbulent flow from atria contracting against non-compliant ventricle
When do you hear a fourth heart sound?
Directly before S1
Where is the best point to listen to heart sounds? (S1 and S2)
Erb’s point
Third intercostal space left sternal border
What mnemonic should you use to assess a murmur?
SCRIPT
Site- where is it loudest
Character- soft/blowing/crescendo etc.
Radiation- heard over carotids or axilla
Intensity- what grade is the murmur
Pitch- high-pitched or low and rumbling
Timing- systolic or diastolic
What are the different murmur grades?
How do you present a murmur?
ITS RPC
This patient has a harsh / soft / blowing, Grade …, systolic / diastolic murmur
Heard loudest in the aortic / mitral / tricuspid / pulmonary area, that does not / radiates to the carotids / left axilla
It is high / low pitched and has a crescendo / decrescendo / crescendo-decrescendo shape
This is suggestive of a diagnosis of mitral stenosis / aortic stenosis
What is the most common valvular heart disease?
Aortic stenosis
Most common indication for valve replacement
Outline aortic stenosis
Ejection-systolic
High-pitched
Crescendo-decrescendo
Radiates to carotids
Thrill in aortic area
Slow rising pulse
Narrow pulse pressure
Exertional syncope
What are the causes of aortic stenosis?
Age-related calcification
Bicuspid aortic valve
Rheumatic heart disease
Outline aortic regurgitation
(also called Austin-Flint murmur)
Early diastolic
Soft murmur
Rumbling murmur
Thrill in aortic area
Collapsing pulse
Wide pulse pressure
Heart failure and pulmonary oedema
Collapsing pulse
What are the causes of aortic regurgitation?
Age-related weakness
Bicuspid aortic valve
Ehlers-Danlos syndrome and Marfan syndrome
Outline mitral stenosis
Mid-diastolic
Low-pitched rumbling
Tapping apex beat, prominent S1
Malar flush (due to back pressure of blood into pulmonary system, causing a rise in CO2 and vasodilation)
Atrial fibrillation (left atrium struggles to push blood through stenotic valve, causing strain)
