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HYMS Y5 > HEART DEFECTS + MURMURS > Flashcards

HEART DEFECTS + MURMURS Flashcards

1
Q

Cause of S1?

A

Closing of AV valves (tricuspid + mitral) at the start of ventricular contraction.

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2
Q

Cause of S2?

A

Closing of SL valves (pulmonary and aortic) once systole is complete.

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3
Q

When does S3 happen?

A

~0.1 seconds after S2.

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4
Q

In which patients is an S3 normal?

A

Young + healthy 15-40 year olds.

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5
Q

In which patients is an S3 pathological?

A

In older patients where the ventricles + chordae tendinae are stiff + weak so reach their limit much faster.

This can indicate heart failure.

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6
Q

What causes the S3 sound?

A

The chordae tendinae being pulled to their full length.

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7
Q

When is S4 heard?

A

Directly before S1.

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8
Q

What does an S4 indicate?

A

A stiff or hypertrophic ventricle caused by turbulent flow from an atria contracting against a non-compliant ventricle.

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9
Q

When is an S4 sound pathological?

A

Always.

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10
Q

The bell of a stethoscope hears what sounds?

A

Low-pitched sounds.

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11
Q

The diaphragm of a stethoscope hears what sounds?

A

High-pitched sounds.

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12
Q

What is Erb’s point?

A

The position in the third intercostal space on the left sternal border which is the best area for listening to heart sounds.

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13
Q

Mneomonic for assessing a murmur?

A 
S - site
C - character
R - radiation
I - intensity
P - pitch
T - timing
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14
Q

Gradings of a murmur?

A
  1. difficult to hear
  2. quiet
  3. easy to hear
  4. easy to hear + palpable thrill
  5. can hear with stethoscope barely touching chest
  6. can hear with stethoscope off chest
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15
Q

Mitral stenosis causes what structural change?

A

left atrial hypertrophy

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16
Q

Aortic stenosis causes what structural change?

A

left ventricular hypertrophy

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17
Q

Mitral regurgitation causes what structural change?

A

left atrial dilatation

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18
Q

Aortic regurgitation causes what structural change?

A

left ventricular dilatation

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19
Q

2 causes of mitral stenosis?

A

rheumatic heart disease

infective endocarditis

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20
Q

Mitral stenosis murmur?

A

Mid-diastolic, low-pitched ‘rumbling’ murmur.

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21
Q

Features associated with mitral stenosis?

A

loud S1

tapping apex beat

malar flush - back pressure of blood into the pulmonary system = rise in CO2 + vasodilation.

AF - left atrium struggles to push blood through stenotic valve = strain + electrical disruption.

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22
Q

End result of mitral regurgitation?

A

CCF as the leaking valve causes a reduced ejection fraction + backlog of blood.

23
Q

Mitral regurgitation murmur?

A

pan-systolic, high-pitched ‘whistling’ murmur

24
Q

Mitral regurgitation associations?

25
Q

3 causes of mitral regurgitation?

A 
idiopathic weakening of the valve with age
IHD
IE
RHD
CTDs (EDS/ Marfan's)
26
Q

Aortic stenosis murmur?

A

Ejection systolic, high-pitched, crescendo-decrescendo murmur

27
Q

3 signs of aortic stenosis?

A

Murmur radiation to carotids.
Slow-rising pulse.
Narrow pulse pressure.
Exertional syncope.

28
Q

2 causes of aortic stenosis?

A

Idiopathic age related calcification.

RHD.

29
Q

Aortic regurgitation murmur?

A

Early diastolic, soft murmur.

30
Q

Signs associated with aortic regurgitation?

A

Collapsing pulse.

Austin-Flint murmur (heard at apex + is an early diastolic, ‘rumbling’ murmur).

31
Q

2 causes of aortic regurgitation?

A

Idiopathic age related weakness.

CTDs (EDS/ Marfan’s).

32
Q

Alternative name for innocent murmurs?

A

Flow murmurs.

33
Q

Features of innocent murmurs?

A 
Soft
Short
Systolic
Symptomless
Situation dependent (quieter with standing/ may only appear when child is unwell).
34
Q

3 causes of pan-systolic murmurs in paediatric patients?

A

Mitral regurgitation
Tricuspid regurgitation
VSD

35
Q

Mitral regurgitation murmur?

A

Pan-systolic murmur

Mitral area

36
Q

Tricuspid regurgitation murmur?

A

Pan-systolic murmur

Tricuspid area

37
Q

VSD murmur?

A

Pan-systolic murmur

Left lower sternal border

38
Q

3 causes of ejection systolic murmurs in paediatrics?

A

Aortic stenosis
Pulmonary stenosis
HOCM

39
Q

Aortic stenosis murmur?

A

EJS murmur

Aortic area

40
Q

Pulmonary stenosis murmur?

A

EJS murmur

Pulmonary area

41
Q

HOCM murmur?

A

EJS

4th intercostal space on left sternal border

42
Q

ASD murmur?

A

Mid-systolic, crescendo-decrescendo murmur with a fixed split second heart sound.

Heard loudest at upper left sternal border.

43
Q

Patent ductus arteriosus murmur?

A

Continuous crescendo-decrescendo machinery murmur.

44
Q

The murmur in tetralogy of Fallot is caused by what?

A

Pulmonary stenosis.

45
Q

Type of murmur in tetralogy of Fallot?

A

EJS heard loudest at pulmonary area.

Caused by pulmonary stenosis.

46
Q

3 causes of cyanotic congenital heart disease?

A

Tetralogy of Fallot.
Transposition of the great arteries.
Tricuspid atresia.

47
Q

3 causes of acyanotic congenital heart disease?

A 
VSD
ASD
PDA
Coarctation of the aorta
Aortic valve stenosis
48
Q

Heart problems associated with Down’s syndrome?

A

Most common: endocardial cushion defect (AKA. AV septal canal defects)

Others: VSD, secundum ASD, TOF, isolated PDA.

49
Q

Heart problems associated with Turner’s syndrome?

A

Bicuspid aortic valve (15%)

Coarctation of aorta (5-10%)

50
Q

Heart problems associated with Patau’s syndrome?

A

ASD
VSD
PDA
dextrocardia

51
Q

Heart problems associated with Noonan’s syndrome?

A

Pulmonary stenosis.

52
Q

Heart problems associated with Marfan’s syndrome?

A

Mitral valve prolapse
Aortic dissection
Aortic aneurysm

53
Q

Heart problems associated with Williams syndrome?

A

Supravalvular aortic stenosis.

54
Q

Heart problems associated with fragile X syndrome?

A

Mitral valve prolapse.

HYMS Y5 (11 decks)

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