Heart murmurs Flashcards
S1
“lub”
Atrioventricular valves closing e.g. mitral during systole
S2
“dub”
Semilunar valves closing e.g. aorta during diastole
extra heart sounds
S3 and S4
S3
comes straight after S2
- “ken- tuck-y”
- very subtle
- due to rapid ventricular filling
- chordae tendinae pulled to full length and then ‘twang back’
- young patients: normal
- older: heart failure
S4
- comes straight before S4
- Ten-nes-see
- always abnormal
- stiff or hypertrophic ventricles
- due to turbulent flow of blood coming from atria into the non-compliant ventricle
- stiff or hypertrophic ventricles
if stenosis of a valve what effect does this have on the corresponding chamber
hypertrophy or corresponding chamber i.e. chamber before valve
e. g mitral stenosis= hypertrophy of L.atrium
e. g. aortic stenosis= hypertrophy of L.ventricle
if regurg problem in valve what effect does this have on the corresponding chamber
dilatation of corresponding chamber
e. g mitral regurg= dilatation of L.atrium
e. g. aortic regurg= dilatation of L. ventricle
listening to murmurs
Auscultate with the
-
bell of your stethoscope to better hear low pitched sounds
- reduced velocity of blood
-
diaphragm to listen to high pitched sounds.
- increased velocity of blood
where to listen: aortic
2nd I.C.S right sternal border
where to listen: pulmonary
2nd I.C.S left sternal border
where to listen: tricupsid
5th I.C.S left sternal border
where to listen: mitral
5th I.C.S mid clavicular line (apex area)
what is erbs point
This is in the 3rd intercostal space on the left sternal border and is the best area for listening to heart sounds (S1 and S2).
special manoeuvres for murmurs: patient on left hand side
mitral stenosis
special manoeuvres for murmurs: patient leaning forward and exhaling
aortic regurgitation
mitral stenosis
5th intercostal space mid clavicular line
features
- mid- diastolic murmur
- low pitched rumbling- slow velocity
- accentuation maneuver: lie on left
causes
- rheumatic heart disease
- infective endocarditis
signs
- malar flush
- atrial fibrillation
mitral regurgitation
5th intercostal space mid clavicular line
features
- pan systolic murmur
- high pitched - whistling
- high velocity of blood through leaky valve
- radiates to left axilla
causes
- age related weakening of valve
- IHD
- IE
- rheumatic heart disease
- connective tissue
- Ehlers danlos or marfans
signs
- congestive heart failure
- backlog of blood
aortic stenosis
2nd intercostal space, right sternal edge
most common valve problem
features
- ejection systolic murmur
- high pitched (high velocity of systole)
- crescendo-decrescendo character
- radiates to carotids
causes
- age related calcification
- rheumatic heart disease
signs
- slow rising pulse and narrow pulse pressure
- exertional syncope
aortic regurgitation
2nd intercostal space, left sternal edge
features
- early diastolic, soft murmur
- accentuation maneuvers: lean forward, on expiration
signs
- collapsing pulse
- heart failure
- due to back pressure of blood waiting to get through to the left side of the heart
