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Z Year3 Clinical Skillz > Heart Murmurs > Flashcards

Heart Murmurs Flashcards

1
Q

What is the aetiology of mitral stenosis?

A

rheumatic heart disease (99%)

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2
Q

What is the common presentation of mitral stenosis?

A
  1. SOB and fatigue
  2. Pulmonary oedema / haemopytsis
  3. RHF (late)
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3
Q

How do you describe heart murmurs?

A
  1. Timing
  2. Intensity (thrills are rare so generally grade 2 if quiet and grade 3 if loud)
  3. Position of stethoscope on precordium where heart is loudest
  4. Position of patient when murmur is heard the loudest (usually only relevant to diastolic murmurs)
  5. Quality
  6. Radiation
  7. Systemic features (other heart sounds, characteristics of the apex beat / pulse etc
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4
Q

Where is a mitral stenosis heard the best on the chest?

A

Apex (LHS)

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5
Q

What side of the stethoscope is used to best hear mitral stenosis?

A

bell on expiration

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6
Q

What is the quality of the sound in mitral stenosis?

A

rumbling (low-pitched)

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7
Q

What are associated sounds of heart murmurs?

A
  1. Opening snap
  2. Tapping apex
  3. AF
  4. Loudest first heart sound
  5. Mitral facies (red face)
  6. Signs of RHF (late)
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8
Q

What are the ECG features of mitral stenosis?

A
  1. AF

2. P mitrale (bifid P waves)

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9
Q

What are the CXR features in mitral stenosis?

A
  1. Enlarged left atrium

2. Pulmonary venous congestion

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10
Q

What are the differential diagnosis for mitral stenosis?

A
  1. Austin flint (2ndary to AR)
  2. Carey Coombs (rheumatic fever)
  3. Tricuspid Stenosis (usually rheumatic)
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11
Q

What are the common indications for surgery for heart murmurs?

A
  1. Moderate/severe disease

2. Percutaneous ballon valvuloplasty

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12
Q

What are the contraindications for percutaneous technique (so open repair/replacement)?

A
  1. Persistent LA thrombus
  2. Moderate/severe MR
  3. Rigid calcified valve
  4. Patient needs CABG anyways
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13
Q

What is the aetiology of primary mitral regurgitation (structural)?

A
  1. Rheumatic heart disease
  2. Infective endocarditis
  3. Valve prolapse
  4. Papillary muscle rupture (e.g. post-MI)
  5. Marfan’s
  6. SLE
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14
Q

What is the aetiology of secondary mitral regurgitation (functional)?

A

left ventricle dilation

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15
Q

What is the common presentation of mitral regurgitation?

A
  1. SOB and fatigue

2. Other LVF (orthopnoea, PND)

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16
Q

When is mitral stenosis heard?

A

mid-diastolic

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17
Q

When is mitral regurgitation heard?

A

pan-systolic

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18
Q

What is the intensity of mitral stenosis?

A

1-4

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19
Q

What is the intensity of mitral regurgitation?

A

1-6

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20
Q

Where can mitral regurgitation be heard the best?

A

Apex

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21
Q

Where does mitral regurgitation radiate to?

A

axilla

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22
Q

What does mitral regurgitation sound like?

A

blowing

23
Q

What are the associated sounds of mitral regurgitation?

A
  1. 3rd hearts sound
  2. Thrusting, displaced apex
  3. Quiet 1st heart sound
  4. Obliterated 2nd heart sound
  5. AF
  6. Audible ‘click’ in valve prolapse
24
Q

What are the ECG features of mitral regurgitation?

A
  1. AF

2. VEBs

25
Q

What are the CXR features of mitral regurgitation?

A
  1. Cardiomegaly (late)

2. Cardiac failure

26
Q

What are the differential diagnosis of mitral regurgitation?

A
  1. Ventricular septal defect (esp after MI)
  2. Tricuspid regurgitation
    - pulsatile hepatomegaly
    - giant V waves in JVP
  3. Aortic stenosis
27
Q

What is the medical treatment for mitral stenosis?

A
  1. AF treatment + anticoagulation

2. Diuretics

28
Q

What are the medical Rx for mitral regurgitation?

A
  1. AF Rx + anticoagulation
  2. Diuretics
  3. ACEi (hypertension worsens MR)
29
Q

What are the common indications for surgery for mitral regurgitation?

A
  1. Severe primary disease with symptoms or LV impairment/dilation
  2. Valve repair better than replacement
  3. Controversial if second MR
30
Q

What is the aetiology for aortic stenosis?

A
  1. Rheumatic heart disease
  2. Calcified bicuspid valve (age 50-60)
  3. Calcified tricuspid valve (70+)
31
Q

What is the presentation for aortic stenosis?

A
  1. SOB
  2. Syncope/pre-syncope
  3. Angina
32
Q

When does aortic stenosis occur?

A

ejection systolic

33
Q

What is the normal intensity of aortic stenosis?

A

1-6

34
Q

Where can aortic stenosis murmur be heard best?

A

aortic

35
Q

Where does an aortic stenosis murmur radiate to?

A

carotids

36
Q

What is the quality of sound of an aortic stenosis murmur?

A

crescendo-descrescendo

37
Q

What are the associated sounds with aortic stenosis murmur?

A
  1. 4th heart sound
  2. Heaving apex
  3. Slow-rising pulse
  4. Narrow pulse pressure
  5. Ejection click
  6. Quiet 2nd heart sound (if severe)
38
Q

What are the ECG features for aortic stenosis?

A

LVVH / LV strain pattern

39
Q

What are the differential diagnosis for aortic stenosis?

A
  1. Aortic sclerosis
  2. HOCM
  3. PS (usually congenital)
  4. MR
40
Q

What does HOCM stand for?

A

hypertrophic obstructive cardiomyopathy

41
Q

What is the medical Rx for aortic stenosis?

A

treat HTN

42
Q

What are the common indications for surgery in aortic stenosis?

A
  1. Severe disease plus
    - symptoms or
    - LV impairment
  2. Moderate/severe disease and undergoing CABG or other valve surgery
  3. Intervention in asymptomatic serve AS controversial
  4. TAVI if unfit for open surgery
  5. Valvuloplasty is rare
43
Q

What is the aetiology of aortic regurgitation?

A
  1. Rheumatic heart disease
  2. IE
  3. Luetic heart disease (syphilis)
  4. Bicuspid valve
  5. Hypertension
  6. Aortic dissection
  7. Marfan’s
  8. RA
  9. Ankylosing spondilytis
44
Q

What is the presentation of aortic regurgitation?

A
  1. SOB and fatigue
  2. Palpitations
  3. Often asymptomatic
45
Q

When does aortic regurgitation show up?

A

early diastolic

46
Q

What is the intensity of aortic regurgitation?

A

1-4

47
Q

Where can aortic regurgitation be heard the best?

A

lower left sternal angle

48
Q

What position should the patient be in and what side of the stethoscope be used for aortic regurgitation?

A

sitting up and with expiration (diaphragm)

49
Q

What is the quality of sound with aortic regurgitation?

A

breath like (high pitched)

50
Q

What are the associated sounds with aortic regurgitation?

A
  1. 3rd heart sound
  2. Thrusting displaced apex
  3. Collapsing pulse
  4. Wide pulse pressure
  5. Eponymous signs
  6. Austin-flint murmur (mid-diastolic)
51
Q

What are the CXR features for aortic regurgitation?

A
  1. Cardiomegaly

2. Cardiac failure

52
Q

What are the differential diagnosis of aortic regurgitation?

A
  1. pulmonary regurgitation

2. Graham steele (PR secondary to pulmonary hypertension

53
Q

What is the medical Rx of aortic regurgitation?

A
  1. Diuretics

2. Vasodilators

54
Q

What are the common indications for surgery with aortic regurgitation?

A

Serve disease plus

  • Symptoms or
  • LV impairment / dilation

Z Year3 Clinical Skillz (9 decks)

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