Heart Murmurs Flashcards
What causes aortic stenosis?
Rheumatic heart disease
Calcified bicuspid valve (age)
Calcified tricuspid valve (age)
How does aortic stenosis present?
SOB
Syncope or pre-syncope
Angina
How would you describe a murmur?
TIPPQRS
Timing Intensity Position on precordium where it is loudest Position of pt when murmur is loudest Quality Radiation Systemic features
How would you describe an aortic stenosis murmur?
Ejection-systolic ‘crescendo-decrescendo’ murmur loudest at aortic area
The murmur of aortic stenosis commonly radiates to the carotid arteries
Loudest on expiration and when the patient is sitting forwards
What are associated clinical features for aortic stenosis?
Slow rising pulse with narrow pulse pressure
Non-displaced, heaving apex beat
Reduced or absent S2
How would you describe a mitral regurgitation murmur?
Mitral regurgitation is associated with a pansystolic murmur heart loudest over the mitral area and radiating to the axilla.
What causes mitral regurgitation?
Rheumatic heart disease IE Valve prolapse Papillary muscle rupture after MI Marfan's
What features are associated with mitral regurgitation?
Displaced, hyperdynamic thrusting apex beat
Quiet 1st heart sound
What causes mitral stenosis?
Rheumatic heart disease
How would you describe a mitral stenosis murmur?
Mid-diastolic low-pitched rumbling murmur radiating to the apex
What features are associated with mitral stenosis?
A low-volume pulse which may be irregularly, irregular (atrial fibrillation is common in mitral stenosis)
Loud first heart sound with tapping apex beat (due to a palpable closing of the mitral valve)
A malar flush (plum-red discolouration of the cheeks)
What causes aortic regurgitation?
AR can occur due to a disease process affecting the valve itself, or due to dilatation of the aortic root.
Diseases affecting the valve include: Congenital bicuspid aortic valve Rheumatic heart disease Infective endocarditis Causes of aortic root dilatation include:
Aortic dissection: can result in acute aortic regurgitation
Connective tissue diseases (e.g. Marfan’s)
Aortitis
How would you describe an aortic regurgitation murmur?
Early diastolic decrescendo murmur heard loudest at the left sternal edfe
Best heard when sitting up and on expiration
What is an Austin Flint murmur?
A low pitched rumbling mid-diastolic murmur heard best at the apex. This is caused by the regurgitated blood through the aortic valve mixing with blood from the left atrium, during atrial contraction.
An Austin Flint murmur is a sign of severe aortic regurgitation.
What features are associated with aortic regurgitation?
Collapsing pulse (a ‘water hammer pulse’ with wide pulse pressure)
Displaced, hyperdynamic apex beat
