Heart murmurs Flashcards
Aortic stenosis murmur name
ejection systolic murmur
Where is aortic stenosis murmur loudest?
over aortic valve
Where can an aortic stenosis murmur radiate?
carotid arteries
Causes of aortic stenosis
calcification of aortic valves (mainly in the elderly)
congenital abnormality of aortic valve (bicuspid)
rheumatic heart disease
How can aortic stenosis murmur be accentuated?
sitting forwards
expiration
Clinical features of aortic stenosis
slow rising pulse
narrow pulse pressure
non-displaced, heaving apex beat (indicates left ventricular hypertrophy)
reduced or absent S2
Reverse splitting of S2 (aortic valve closes after pulmonary valve)
Mitral regurgitation murmur name
pansystolic murmur
Where is mitral regurgitation murmur loudest?
over mitral area
Where can mitral regurgitation murmur radiate?
axilla
Causes of mitral regurgitation
infective endocarditis
acute MI with rupture of papillary muscles
rheumatic heart disease
congenital defects of mitral valve
cardiomyopathy
How can mitral regurgitation murmur be accentuated?
expiration
left lateral decubitus position
Clinical feature of mitral regurgitation
displaced, hyperdynamic apex beat
Aortic regurgitation murmur name
early diastolic murmur
Where is aortic regurgitation murmur heard loudest?
left sternal edge
What diseases affecting the valve can cause aortic regurgitation?
congenital bicuspid aortic valve
rheumatic heart disease
infective endocarditis
What diseases causing aortic root dilatation can cause aortic regurgitation?
aortic dissection
connective tissue diseases (eg. Marfan’s)
aortitis
Clinical features of aortic regurgitation
collapsing pulse
displaced, hyperdynamic apex beat
What is an Austin Flint murmur and what is it a sign of?
low pitched rumbling mid diastolic murmur heard best at the apex
caused by regurgitated blood through the aortic valve mixing with blood from the left atrium during atrial contraction
sign of severe aortic regurgitation
Eponymous clinical signs of aortic regurgitation
Corrigan’s sign = visible distention and collapse of carotid arteries in the neck
De Musset’s sign = head bobbing with each heartbeat
Quincke’s sign = pulsations are seen in the nail bed with each heartbeat when the nail bed is lightly compressed
Traube’s sign = ‘pistol shot’ sound heard when stethoscope placed over the femoral artery during systole and diastole
Muller’s sign = uvula pulsations are seen with each heartbeat
Mitral stenosis murmur name
mid-diastolic murmur
Where is mitral stenosis murmur loudest?
over apex
What can cause mitral stenosis?
rheumatic heart disease = most common
rarer causes:
- congenital
- left atrial myxoma
- connective tissue disorders
- mucopolysaccharidosis
How can mitral stenosis murmur be accentuated?
left lateral decubitus position
expiration
What does RILE mean?
right inspiration
left expiration
murmurs from left-sided valves heard loudest on expiration
murmurs from right-sided valves heard loudest on inspiration
Clinical features of mitral stenosis
low volume pulse, may be irregularly irregular (AF common in mitral stenosis)
loud first heart sound with tapping apex beat
malar flush
Mitral valve prolapse murmur name
combination of mid-systolic click and mid-late systolic murmur
Tricuspid regurgitation murmur name
pansystolic murmur
loudest over tricuspid region
Causes of tricuspid regurgitation
right ventricular dilatation (eg. secondary to pulmonary stenosis or pulmonary hypertension)
rheumatic fever
infective endocarditis (esp. IVDU)
carcinoid syndrome
congenital (eg. atrial septal defect, Ebstein anomaly)
Clinical features of tricuspid regurgitation
large ‘v-waves’ visible in jugular veins
visible/palpable hepatic pulsations
signs of right-sided heart failure (right ventricular heave, peripheral oedema, hepatomegaly, ascites)
Pulmonary stenosis murmur name and features
ejection systolic murmur
loudest over pulmonary area
loudest during inspiration
radiates to left shoulder/left infraclavicular region
Pulmonary stenosis causes
congenital (Turner’s, Noonan’s and William’s syndromes, tetralogy of fallot)
rheumatic fever
carcinoid syndrome
Clinical features of pulmonary stenosis
prominent ‘a-waves’ in jugular veins
widely split S2
P2 may be soft and inaudible
right ventricular dilatation can cause right ventricular heave, tricuspid regurgitation and peripheral signs of right-sided heart failure
Pulmonary regurgitation murmur
rare
early decrescendo murmur
loudest over left sternal edge
usually due to pulmonary hypertension
often asymptomatic
Causes of pulmonary regurgitation
pulmonary hypertension
infective endocarditis
congenital valvular heart disease
Tricuspid stenosis murmur name
soft diastolic murmur
loudest 3rd-4th intercostal space, left sternal edge
loudest on inspiration
Causes of tricuspid stenosis
rheumatic fever
congenital disease
infective endocarditis
Clinical features of tricuspid stenosis
raised JVP with giant ‘a-waves’
peripheral oedema
ascites
