Characterisation of murmurs Flashcards
Murmurs can be ……. or ……..
Physiological or pathological
Physiological murmurs include
Ejection murmurs (blood accelerating out of the great vessels),
Filling murmurs (Ventricular filling)
Pathological murmurs are diastolic or systolic, these include..
Systolic = mitral regurgitation, tricuspid regurgitation,
Diastolic = Aortic regurgitation
Murmurs can be described based on
Timing
Grade
Point of maximal intensity
Radiation
Character and shape
Systole describes
between S1 and S2
Diastole describe
between S2 and S1
What does holo mean when describing a murmur?
Between heart sounds
can still hear the S1 and S2
What does pan mean when describing a murmur?
Across heart sounds
Don’t hear S1 and S2
What is longer in horses, systole or diastole?
Diastole
How many grades of murmurs are there is horses
6
Describe a Grade 1 heart murmur
very quiet
localised
Describe a grade 2 heart murmur
quieter than S1/S2
describe a grade 3 murmur
similar volume to S1/S2
Describe a grade 4 murmur
louder than S1/S2
Describe a grade 5 murmur
palpable thrill on chest wall
Describe a grade 6 murmur
audible with stethoscope off the chest wall
How can murmur radiation be charcterised
Cranially
Caudally
Dorsally
Ventrally
Laterally to either side of chest
List the 5 ways you and describe the shape of a murmur
Band/plateau
crescendo
decrescendo
crescendo-decrescendo
decrescendo-crescendo
Describe a band murmur
the sound is a constant shape- does not change in intensity
Describe a Crescendo murmur
murmur has increasing intensity
describe a Decrescendo murmur
murmur decreases in intensity as you hear it
Describe a Crescendo-Decrescendo mumur
increasing to decreasing intensity of murmur
Describe a Decrescendo-crescendo murmur
high intensity to low then back to high intensity
List the ways in which we can characterise a murmur
soft harsh
musical
buzzing
blowing
squeak
Describe the signalment of mitral regurgitation in horses
all age groups
Describe an ejection murmur
blood accelerating out of great vessels (aortic and pulmonic)
Describe the clinical signs of mitral regurgitation in horse
Ranges for being incidental to causing collapse and sudden death
describe the Timing of mitral regurgitation
Holosystolic
Pan systolic
Mid to late systolic
PMI for a murmur caused by mitral regurgitation
Left side, over the mitral valve
Describe the shape of mitral regurgitation murmur
band/plateau
crescendo
Describe the Signalment for tricupsid regurgitation
All age groups,. racing TB and SB
Describe the clinical signs of tricupsid regurgitation
Ranges for being incidental to causing collapse and sudden death
Describe the timing of tricuspid regurgitation
Holosystolic
Pansystolic
Describe the PMI of a murmur caused by tricuspid regurgitation
Right
Tricuspid valve
Describe the radiation of a tricuspid murmur
cranio-dorsally
Radiation of Mitral Regurgitation murmur
Caudo-dorsally
Aortic regurgitation is seen in…
Middle aged to older horses
Clinical signs of aortic regurgitation
Commonly incidental, progressive, clinical signs as the animal gets older
Describe the timing of an aortic regurgitation murmur
Holodiastolic
Pandiastolic
Describe the PMI of aoritc regurgitation murmur
Left
Aortic valve
Describe the radiation of aortic regurgitation
caudoventrally, often to right side as well
Describe pulmonic insufficency in horses
Uncommon in horses
common to see on doppler echocardiography but rarely affects performance
List the Well tolerated murmurs in the horse
Physiological murmurs
Tricuspid and mitral regurgitation
○ Without structural valvular lesions
Slowly progressive Aortic regurgitation in middle-aged horses
List poorly tolerated murmurs in the horse
Acute onset murmurs (Ruptured chordae tendinae, Bacterial endocarditis, Valvular disease associated with myocardial disease)
Murmur + Concurrent arrhythmias
Progressive lesions
Describe the Plan for a horse with a murmur
Cardiovascular assessment
Characterise the murmur
Further investigation?- ECG, echocardiography
