Heart Murmurs

Question 1

Most common cause of heart murmurs worldwide / usa

Answer 1

worldwide: rheumatic fever.

usa: senile calcific aortic stenosis (AS) and mitral valve prolapse (MVP)

others: SLE (systemic lupus erythematosus)

Question 2

Aortic stenosis facts

Answer 2

Mainly in elderly, aortic valve may undergo calcific degeneration. Narrowing of aortic orifice.

If middle-aged have it, its prob due to congenital bicuspid aortic valve (BAV)

Question 3

Other causes of murmur besides diseases.

Answer 3

Diet medication, radiation therapy, endocrine conditions

Question 4

How to detect a heart murmur and effectiveness

Answer 4

Auscultation (listening through a stethoscope): Sensitivity of 70% and specificity of 98%. (trainees = 33%).

Echocardiography

Question 5

When do murmurs occur? When is it loudest? Slide 27

Answer 5

Systolic murmur : begins during / after first heart sound and ends before second heart sound.
Diastolic murmur: occurs during heart muscle relaxation between beats.

Question 6

subacute/acute endocarditis facts:

Answer 6

Subacute: Infects mitral valve. most common less virulent such as oral staphylococcus viridans can be introduced systemically via dental procedures.

Acute: Most common staphylococcus aureus. Tricuspid valve affected.

Question 7

Concerns when treating patients with medically complex conditions

Answer 7

Hemostasis: Treat with anticoagulants
Patients susceptibility to developing IE (infective endocarditis): Aortic stenosis and mitral valve prolapse are the most common valvular problems.
Drug actions and interactions:

Question 8

What produces a normal heart sound?

Answer 8

S1: produced mainly by the closure of the atrioventricular (tricuspid and mitral) valves
S2: produced mainly by the closure of the semilunar (aortic and pulmonary) valves.

Question 9

Relevant Murmurs and which one is always abnormal?

Answer 9

Systolic Murmurs, Diastolic Murmurs, Continuous Murmurs, Innocent Murmurs.
Diastolic Murmors = always abnormal

Question 10

Types of systolic murmurs

Answer 10

Aortic stenosis
Mitral regurgitation
Pulmonary stenosis
Tricuspid regurgitation

Question 11

Surface anatomy of cardiac auscultation

Answer 11

Aortic valve: middle of heart. where sternum is.
Tricuspid valve: between 4th and 5th intercostal space
Pulmonary valve: 3rd rib, to the left of aortic valve.
Mitral valve: mid clavicular line on left side.

Question 12

Conditions that can cause / exacerbate an innocent heart murmur

Answer 12

Physical activity / exercise
pregnancy
fever
change in heart structure (aging / heart surgery)
anemia/hypoxemia
hyperthyroidism

Question 13

Most common cause of abnormal murmurs in children

Answer 13

Congenital heart disease.

Question 14

Concerns when treating patients with medically complex conditions

Answer 14

Treatment with anticoagulants, most likely warfarin. Most common cause of atrial fibrillation is rheumatic mitral valve disease.
Aortic Stenosis and mitral valve prolapse = most common valvular problems.

Question 15

High Cardic Risk Patients, what to do

Answer 15

Antibiotic prophylaxis recommended for dental procedures involving gingival tissue, periapical region of teeth, perforation of oral mucosa.

Question 16

Low risk of infective endocarditis, what to do

Answer 16

No need for antibiotic proophylaxis.

Question 17

subacute endocarditis facts

Answer 17

most common less virulent such as oral staphylococcus viridans can be introduced systemically via procedures.
valves infected: mitral valve, aortic valve, tricuspid valve. mitral valve = most.

Question 18

cute endocarditis facts

Answer 18

most common staphylococcus aureus. Occurs most frequently in IV Drugs users.

tricuspid valve affected.