Heart murmurs Flashcards
What is the character of a mitral stenosis murmur? (4)
Mid diastolic
Low pitched
Rumbing (due to low velocity)
Loud S1 due to thick valves requiring large systolic force to shut
Where is the murmur of mitral stenosis best heard?
Apex in left lateral position
Is the murmur of mitral stenosis loudest on inspiration or expiration?
Expiration
Is the murmur of mitral stenosis best heard with the bell or the diaphragm?
Bell
What are possible symptoms of mitral stenosis? (4)
- Dyspnoea
- Fatigue
- Haemoptysis
- Chest pain
What clinical signs are associated with mitral stenosis? (4)
- Malar flush (backpressure into pulmonary system, causing rise in CO2 and vasodilation
- Palpable tapping apex beat
- Signs of pulmonary hypertension (RV heave, loud P2)
- Atrial fibrillation - left atrial struggling to push blood through stenotic valve causing disruption to electrical signals resulting in fibrillation
What is the most common cause of mitral stenosis?
Rheumatic heart disease
What is the character of a mitral regurgitation murmur? (2)
Pan-systolic murmur (throughout systolic period)
High pitched whistling (due to high velocity of blood flow through leaky valve)
Where is the murmur of mitral regurgitation best heard?
Apex
Is the murmur of mitral stenosis loudest on inspiration or expiration?
Expiration
Where does the murmur of mitral regurgitation radiate?
Left axilla
What are possible symptoms of mitral regurgitation? (5)
- Dyspnoea
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Fatigue
- Palpitations
What are clinical signs of mitral regurgitation? (4)
- Atrial fibrillation
- Displaced thrusting apex
- Signs of pulmonary hypertension (RV heave, loud P2)
- Signs of LVF (S3, pulmonary oedema)
What causes mitral regurgitation? (5)
- Idiopathic weaking with age
- Ischaemic heart disease
- Infective endocarditis
- Rheumatic heart disease
- Connective tissue disorders e.g. Ehlers-Danlos Syndrome or Marfan Syndrome
What is the character of an aortic stenosis murmur? (3)
Ejection systolic murmur
High pitched murmur
Crescendo-decrescendo
Where is the murmur of aortic stenosis best heard?
Upper right sternal edge
Where does the murmur of aortic stenosis radiate?
Carotids and apex
Is the murmur of aortic stenosis loudest on inspiration or expiration?
Expiration
What are possible symptoms of aortic stenosis? (3)
- Exertional dyspnoea
- Exertional syncope
- Angina (coronary perfusion impaired)
What clinical signs are associated with aortic stenosis? (4)
- Slow rising pulse
- Narrow pulse pressure
- Heaving apex beat
- Possibly signs of LVF (S3, pulmonary oedema)
What causes aortic stenosis? (4)
What causes aortic stenosis?
- Idiopathic age-related calcification
- Rheumatic heart disease
- Bicuspid aortic value (e.g. Turner’s syndrome)
- Congenital
What is the character of an aortic regurgitation murmur? (2)
Early diastolic
Soft (sounds like a breath)
What is the murmur of aortic regurgitation best heard?
Upper right sternal edge or lower left sternal edge when sitting forwards
Is the murmur of aortic regurgitation loudest on inspiration or expiration?
Expiration
What are possible symptoms of aortic regurgitation? (3)
- Fatigue
- SOB
- Palpitations
What clinical signs are associated with aortic regurgitation?
- Collapsing Pulse
- Wide pulse pressure
- Very displaced thrusting apex
- ? Austin Flint murmur (apical early diastolic rumbling)
- Signs of heart failure
- Signs of backflow (Corrigan’s (visable pulsation), de Musset’s (head-nodding pulse), Quincke’s (red-coloured pulsation in nails)
What causes aortic regurgitation? (6)
What causes aortic regurgitation?
- Idiopathic age-related weakness
- Connective tissue disorders e.g. Ehlers-Danlos Syndrome or Marfan Syndrome
- Infective endocarditis
- Aortic dissection
- Rheumatic heart disease
- Longstanding hypertension
