CVPR Week 3: Listening to heart murmurs Flashcards
What causes heart murmurs?
Turbulent flow
Turbulent flow
Forward flow
Backward flow
Shunt from left side circulation to right side or vice versa
What determines how loud a murmur is?
2 listed
- Degree of turbulence
- Shape and thickness of the chest wall
What determines the length of time a murmur can be heard?
Length proportional to the duration of turbulence
How do we describe murmurs?
5 listed
- Timing *systole vs diastole)
- Intensity
- Location
- Radiation
- Frequency (pitch)
- Related to velocity
- Stethoscope to help distinguish frequencies
Stethoscope: Bell for?
Low frequencies
Stethoscope: Diaphragm for?
high frequencies
Grading of heart murmurs
Grade 1 Heart Murmur
Very faint
not always heard in all positions
Grade 2 Heart Murmur
quiet but not difficult to hear
Grade 3 Heart Murmur
moderately loud
Grade 4 Heart Murmur
Loud +/- thrills
Grade 5 Heart Murmur
- Very loud +/- thrills
- may be heard with stethoscope partly off the chest
Grade 6 Heart Murmur
- may be heard with stethoscope completely off the chest
- +/- thrills
Cardiac Auscultation sites
Shape of murmurs
- Systolic
- Diastolic
Evaluating Cardiac Murmurs
9 listed
Position of murmur
Position of murmur: Supine
General auscultation and most heart sounds
Position of murmur: Sitting up and leaning forward and holding exhalation
- Aortic stenosis
- aortic regurgitation
- Pericardial rubs
Position of murmur: Left lateral decubitus
S3, S4, Mitral stenosis (using bell of stethoscope)
Position of murmur: Valsalva manoeuver
increases intensity of mitral valve prolapse and hypertrophic cardiomyopathy
decreases intensity of aortic stenosis
Position of murmur: Squating and standing
- increases intensity of aortic stenosis
- Decreases intensity of outflow obstruction in hypertrophic cardiomyopathy
Describe
Heart sound questions: S1
S1
C: During isovolumetric contraction
Heart sound questions: S2
S2
during isovolumetric relaxation
S3 occurs when?
S4 occurs when?
Pressure-volume loop
In what phase of the pressure-volume loop is this heart?
Isovolumetric relaxation
In what phase of the pressure-volume loop is this heart?
Ejection
Echo imaging of the heart
The most familiar form of imaging of the heart
Echo imaging of the heart
Appears like a movie strip with continuous action through a slice of the heart
Echo imaging of the heart
2D imaging produces a “thin slice” through the part of the heart being interrogated
Echo imaging of the heart
Identify
Current role of Echocardiography
How is Echo used?
Identify
On the pressure-volume loop, when would one hear the murmur of aortic stenosis?
What is this?
Aortic stenosis
Where is aortic stenosis best heard?
right second intercostal space on the sternal border
How is the sound of Aortic stenosis described?
as a crescendo-decrescendo systolic ejection murmur
What is this?
aortic regurgitation
Where is aortic regurgitation best heard
along the right sternal border in the 2nd intercostal space
How is the sound of aortic regurgitation described?
It is described as an early diastolic decrescendo murmur
aortic regurgitation can be present with?
a bounding pulse or wide pressure pulse
common causes of aortic regurgitation?
- Bicuspid aortic valve
- endocarditis
- Rheumatic fever
- Aortic root dilation
What is this?
S3 heart sound
This is the the sound of the S3 heart sound. It is heard normally in young adults and children, in pregnancy and athletes. It is abnormal older adults and may signify heart failure or cardiomyopathy.
Best patient position to hear the S3 heart sound?
- Left lateral decubitus position
- on the cardiac apex in the 5th intercostal space
S3 heart sound should be listed to with which part of the stethoscope?
The bell and should be faint or absent with the diaphragm
S3 heart sound is produced by?
blood coming into contact with a compliant ventricle
S3 heart sound in elderly may signify?
- Heart failure
- Cardiomyopathy
- Severe mitral or tricuspid regurgiation
How is the S3 heart sound described?
The S3 has a low pitch vs the split S2 which is high pitched
What is this?
Holosystolic murmur
Holosystolic murmur is produced by?
Typically caused by mitral & Tricuspid regurgitation
or
Ventricular septal defects
Holosystolic murmur is best heard where?
Holosystolic murmur radiation?
Holosystolic murmur sound is described as
a high pitched blowing murmur
Holosystolic murmur common causes
- Mitral valve disease
- Rheumatic fever
- mitral valve prolapse
- infective endocarditis
- congenital abnormality through a hole in the interventricular septum
What is this?
Normal heart sound
What is this?
S4 heart sound
Atrial gallop AKA
S4 heart sound
The best place to hear the S4 heart sound?
- lateral left decubitus position
- with the bell of the stethoscope
The S4 heart sound is a sign of?
Diastolic heart failure
The S4 heart sound is produced by?
when the atria contract forcing blood into a non-compliant ventricle
often heard in severe left ventricular hypertrophy
often heard in severe left ventricular hypertrophy
S4 heart sound
Often heard during active cardiac ischemia
S4 heart sound
What is this?
Mitral stenosis
Mitral stenosis is best heard?
Mitral stenosis is produced by?
rapid closing of thickened mitral valves
caused by the valve cusps snaping into the left ventricle
Mitral stenosis sound is described as?
low-pitched decrescendo-crescendo rumbling diastolic murmur
Mitral stenosis becomes louder by?
valsalva maneuver, squating or activities that increase afterload
On the pressure-volume loop when would you hear the murmur of mitral stenosis?
On the pressure-volume loop when would you hear the murmur of mitral regurgitation?
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