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Cardiology Y1 > Heart Murmurs > Flashcards

Heart Murmurs Flashcards

1
Q

What causes the 1st heart sound (S1)

A

closing of atrioventricular valves ( tricuspid and mitral ) at the start of systolic contraction of ventricles

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2
Q

What causes the 2nd heart sound (S2)

A

closing of semilunar valves ( aortic and pulmonary ) once systolic contraction is complete

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3
Q

What causes the 3rd heart sound (S3) and when is it heard

A

Heard 0.1 seconds after S2 , S3 is the sound of chordae tendineae pulling to their full length due to rapid ventricular filling

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4
Q

What can S3 indicate when heard

A

In elderly patients it can indicate heart failure due to ventricles and chordae being stiff and weak that they reach their limit faster than normal

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5
Q

When can hearing S3 be normal and why

A

in young healthy people ( 15-40 ) S3 can be normal since the heart functions so well that the ventricles easily allow rapid filling.

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6
Q

What causes the 4th heart sound and when is it heard

A

S4 is heard directly before S1. It’s abnormal and hard to hear.
Caused by turbulent flow from atria contracting against non-compliant ventricle.

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7
Q

What can hearing a S4 indicate

A

A stiff or hypertrophic ventricle

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8
Q

Which side of the stethoscope is used to hear low pitched sounds and which is used to hear high pitched sounds

A

Bell : low pitched

Diaphragm : high pitched

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9
Q

Where is the pulmonary valve located

A

2nd ICS left sternal border

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10
Q

Where is the Aortic valve located

A

2nd ICS right sternal border

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11
Q

Where is the Tricuspid valve located

A

5th ICS left sternal border

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12
Q

Where is the Mitral valve located

A

5th ICS mid clavicular line ( apex area )

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13
Q

What is Erb’s point and where is it

A

The area best for listening to S1 & S2 heart sounds.

Located in the 3rd ICS on the left sternal border

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14
Q

What special maneuvers can be used to emphasize certain murmurs ( Hint: 2 )

A

1- Mitral stenosis : patient on left hand side

2- Aortic regurgitation : patient sat up, leaning forward and holding exhalation

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15
Q

List what is assessed in a Murmur

A

S: Site ( where is it loudest )
C: Character ( soft/blowing/crescendo/decrescendo)
R: Radiation ( radiate in carotid or left axilla )
I: Intensity ( what grade )
P: Pitch ( low/high/grumbling)
T: Timing ( systolic or diastolic)

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16
Q

Explain how to grade a murmur ( Hint : 6)

A 
1- Difficult to hear 
2- Quiet 
3- Easy to hear 
4- Easy to hear with a palpable thrill 
5- Can hear with stethoscope barely touching chest 
6- Can hear with stethoscope off chest
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17
Q

When in doubt what grade is the murmur probably

A

2 or 3

18
Q

What is the difference between Hypertrophy or Dilation of myocardium

A

Hypertrophy : thickening outwards and into the chamber

Dilation : thinking and expanding of myocardium

19
Q

What can cause Myocardial Hypertrophy and give the 2 possible conditions and their result

A

Pushing against a stenotic valve will cause myocardial hypertrophy.
1- Mitral stenosis = left atrial hypertrophy
2- Aortic stenosis = left ventricular hypertrophy

20
Q

What can cause Myocardial Dilation and give the 2 possible conditions and their result

A

Leaky valve allowing blood flow back into a chamber will stretch the muscle resulting in dilation.
1- Mitral regurgitation = left atrial dilation
2- Aortic regurgitation = left ventricular dilation

21
Q

What is mitral stenosis

A

Narrowing of the mitral valve that makes it difficult for the left atrium to pump blood through to the ventricle.

22
Q

What are the causes of Mitral stenosis ( Hint: 2 )

A

1- Rheumatic Heart Disease

2- Infective Endocaaditis

23
Q

Describe the murmur caused by Mitral Stenosis

A

Mid-diastolic , low pitches rumbling murmur ( due to low velocity of blood )

24
Q

Which heart sound will change due to mitral stenosis

A

S1 will be loud due to thick valves requiring large systolic force to shut and then shutting suddenly

25
Q

What is associated with Mitral stenosis and why ( Hint: 2 conditions )

A

1- Malar Flush: back pressure of blood into pulmonary system will cause rise in CO2 and vasodilation
2- Atrial Fibrillation : left atrium struggling to push blood will cause electric disruptions

26
Q

What is Mitral Regurgitation

A

Incompetent mitral valve allows blood to flow back through during systolic contraction of left ventricle .

27
Q

What is the end result of Mitral regurgitation

A

Will result in congestive cardiac failure as leaking valve will reduce ejection fraction and will result in a backlog of blood waiting oil left atria to be pumped through left side of heart.

28
Q

Describe the murmur caused by mitral regurgitation

A

Pan-systolic , high pitched whistling ( due to high velocity of blood flow ).
Murmur radiates to left axilla

29
Q

What heart sound could be heard due to mitral regurgitation

A

S3

30
Q

What are the causes of Mitral Regurgitation ( Hint:5)

A 
1- Idiopathic weaning of valve with age 
2- Ischaemic heart disease 
3- infective Endocarditis 
4- Rheumatic Heart Disease 
5- Connective tissue disorders ( marfan or Ehlers danlos )
31
Q

Describe the murmur heard due to Aortic stenosis

A

Ejection-systolic , high pitched murmur ( high velocity of systole ). Crescendo-decrescendo character due to different blood flow speeds during systole. Murmur radiates to carotid.

32
Q

What causes the crescendo-decrescendo character or an aortic stenosis murmur

A

The flow of blood is slowest at the start and end of systole and fastest in the middle.

33
Q

What are signs of Aortic stenosis other than a murmur

A

1- Slow rising pulse
2- Narrow pulse pressure
2- Exertional syncope

34
Q

What are the causes of aortic stenosis ( Hint: 2 )

A

1- Idiopathic age related calcification

2- Rheumatic Heart Disease

35
Q

Describe the murmur heard due to Aortic Regurgitation

A

Early diastolic, soft murmur.

Can cause an Austin-Flint murmur that’s heard at the apex as an early diastolic rumbling murmur.

36
Q

What sign is aortic regurgitation also associated with

A

Corrigan’s pulse. collapsing pulse that is rapidly appearing and disappearing at the carotid.

37
Q

What causes Corrigan’s pulse

A

Blood pumped out by ventricles immediately flows back through the aortic valve into the ventricles again.

38
Q

What is the end result of Aortic Regurgitation

A

Heart failure due to back pressure of blood in left side of heart

39
Q

What causes the Austin-Flint murmur

A

blood flowing back through aortic valve and over the mitral valve causes it to vibrate

40
Q

What are the causes of aortic regurgitation ( Hint: 2)

A

1- Idiopathic age related weakness

2- Connective tissue disorders ( Marfan or Ehlers )

Cardiology Y1 (12 decks)

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