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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
3 causes of mitral regurgitation?
``` idiopathic weakening of the valve with age IHD IE RHD CTDs (EDS/ Marfan's) ```
26
Aortic stenosis murmur?
Ejection systolic, high-pitched, crescendo-decrescendo murmur
27
3 signs of aortic stenosis?
Murmur radiation to carotids. Slow-rising pulse. Narrow pulse pressure. Exertional syncope.
28
2 causes of aortic stenosis?
Idiopathic age related calcification. | RHD.
29
Aortic regurgitation murmur?
Early diastolic, soft murmur.
30
Signs associated with aortic regurgitation?
Collapsing pulse. | Austin-Flint murmur (heard at apex + is an early diastolic, 'rumbling' murmur).
31
2 causes of aortic regurgitation?
Idiopathic age related weakness. | CTDs (EDS/ Marfan's).
32
Alternative name for innocent murmurs?
Flow murmurs.
33
Features of innocent murmurs?
``` Soft Short Systolic Symptomless Situation dependent (quieter with standing/ may only appear when child is unwell). ```
34
3 causes of pan-systolic murmurs in paediatric patients?
Mitral regurgitation Tricuspid regurgitation VSD
35
Mitral regurgitation murmur?
Pan-systolic murmur | Mitral area
36
Tricuspid regurgitation murmur?
Pan-systolic murmur | Tricuspid area
37
VSD murmur?
Pan-systolic murmur | Left lower sternal border
38
3 causes of ejection systolic murmurs in paediatrics?
Aortic stenosis Pulmonary stenosis HOCM
39
Aortic stenosis murmur?
EJS murmur | Aortic area
40
Pulmonary stenosis murmur?
EJS murmur | Pulmonary area
41
HOCM murmur?
EJS | 4th intercostal space on left sternal border
42
ASD murmur?
Mid-systolic, crescendo-decrescendo murmur with a fixed split second heart sound. Heard loudest at upper left sternal border.
43
Patent ductus arteriosus murmur?
Continuous crescendo-decrescendo machinery murmur.
44
The murmur in tetralogy of Fallot is caused by what?
Pulmonary stenosis.
45
Type of murmur in tetralogy of Fallot?
EJS heard loudest at pulmonary area. Caused by pulmonary stenosis.
46
3 causes of cyanotic congenital heart disease?
Tetralogy of Fallot. Transposition of the great arteries. Tricuspid atresia.
47
3 causes of acyanotic congenital heart disease?
``` VSD ASD PDA Coarctation of the aorta Aortic valve stenosis ```
48
Heart problems associated with Down's syndrome?
Most common: endocardial cushion defect (AKA. AV septal canal defects) Others: VSD, secundum ASD, TOF, isolated PDA.
49
Heart problems associated with Turner's syndrome?
Bicuspid aortic valve (15%) | Coarctation of aorta (5-10%)
50
Heart problems associated with Patau's syndrome?
ASD VSD PDA dextrocardia
51
Heart problems associated with Noonan's syndrome?
Pulmonary stenosis.
52
Heart problems associated with Marfan's syndrome?
Mitral valve prolapse Aortic dissection Aortic aneurysm
53
Heart problems associated with Williams syndrome?
Supravalvular aortic stenosis.
54
Heart problems associated with fragile X syndrome?
Mitral valve prolapse.

HYMS Y5 (11 decks)

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