Heart Murmurs Flashcards
Aortic stenosis Signs Peripheral Pulse Precordium Murmur Symptoms
peripheral: Nil Pulse: Slow rising, narrow PP Praecordium: forceful apex, soft S2 (?S4) Murmur: ESM radiating to carotids Symptoms: Syncope, angina, dyspnoea
Aortic stenosis management
Open or TAVI
Open if undergoing CABG
Aortic regurg Signs Peripheral Pulse Precordium Murmur Symptoms
Peripheral: retinal artery, carotid, nail bed, uvula pulsations
Nodding head (De Musset)
Pistol shot femorals
Pulse: Waterhammer, wide pulse pressure
Precordium: displaced apex, soft S2 (?S3)
Murmur: Early DM, LLSE at Erb’s point
May also have MDM due to MS (Austin-Flint)
Symptoms: LVF
aortic regurg management
Medical: reduce afterload (ACEi, BB, diuretics)
Surgical: valve replacement BEFORE LV gets dilated
Mitral stenosis Peripheral Pulse Precordium Murmur Symptoms
Peripheral: malar flush
Pulse: AF
Precordium: tapping apex, non-displaced, parasternal heave, loud S1
Murmur: Mid-diastolic murmur radiating to axilla
Symptoms: LVF, AF
ECG change in MS/MR
bifid P wave, AF
MS management
Medical: RhF prophylaxis (Benpen)
AF management
Diuretics for symptomatic
Surgical: balloon valvuloplasty, valvotomy or replacement
MR Peripheral Pulse Precordium Murmur Symptoms
Peripheral: Nil Pulse: AF precordium: Apex displaced Soft S1 Murmur: PSM Symptoms: AF, LVF
Left Ventricular Wall Rupture
new pansystolic
Possible thrill
HOCM
Ejection Systolic +/- Pan systolic
increased with valsalva, decreased with squatting
mitral valve prolapse
mid-systolic click, late systolic murmur
Meaning of S3
Rapid ventricular filling of compliant ventricle
Heart failure, MR, constrictive pericarditis, high out put states
Meaning of S4
Atrial contraction against stiff ventricle
Hypertension, AS
