Heart Murmurs Flashcards
What is the definition of a heart murmur?
The sound detected when TURBULENT BLOD FLOW occurs:
- through the great vessels or
- across a heart valve
What are the most common types of heart murmurs?
Valves:
- Aortic
- Mitral
Descriptions*:
- Stenotic: does not OPEN properly
- Regurgitant: does not CLOSE properly
*Both are mechanical problems that can become electrical
How are heart murmurs identified?
Systolic vs Diastolic:
- Systolic = in sync with carotid pulse
- Diastolic = out of sync with carotid pulse
Aortic vs Mitral (which valve):
- heard loudest at respective listening points
Associated findings
Where are the aortic and mitral listening points?
Aortic listening point:
- 2nd intercostal space
- Right eternal border
Mitral listening point:
- apex of heart
When should heart murmurs be referred?
Diastolic murmurs are ALWAYS ABNORMAL and should ALWAYS be referred!**
Systolic murmurs with associated findings should USUALLY be referred, especially with:
- HF
- angina
Name a pneumonic for recalling systolic (vs diastolic) murmurs.
Systolic Murmurs pneumonic: MR Peyton Manning AS MVP
MR: Mitral Regurgitation
Peyton Physiologic
Manning: Murmur
AS: Aortic Stenosis
MVP: Mitral Valve Prolapse
Name a pneumonic for recalling diastolic (vs systolic) murmurs.
Diastolic Murmurs pneumonic: ARMS***
AR: Aortic Regurgitation
MS: Mitral Stenosis
***Diastolic murmurs are ALWAYS ABNORMAL and should ALWAYS be referred!!!
How are mitral regurgitation heart murmurs identified, including assessment findings, radiograph findings and EKG results?
Assessment findings r/t identification:
- systolic (in sync with carotid artery pulse)
- heard at mitral listening point of 2nd intercostal space at right sternal border
Radiograph findings include enlargement of:
- Left ventricle
- Left atrium
EKG results:
- A-fib is common
Name common etiologies of mitral regurgitation heart murmurs.
- Congenital
- Rheumatic heart disease
- Acute endocarditis
- Calcified annulus
- Mitral valve prolapse (may or may not be related to rheumatic heart disease)
Describe the common course for mitral regurgitation heart murmurs.
- Long asymptomatic period
- Congestive heart disease at 40 - 60 years old
- Decline over about 10 years
What are common associated findings with mitral regurgitation murmurs?
- Shortness of breath
- Fatigue
- Heart failure/Congestive heart failure
- Bacterial endocarditis
How are aortic stenosis murmurs identified, including assessment findings, radiograph findings, and EKG results?
Assessment findings r/t identification:
- systolic (In sync with carotid artery pulse)
- heard at apex of heart
Radiograph findings:
- late cardiomegaly
EKG results:
- usually normal
***Aortic stenosis is often on exam!!!
Name common etiologies of aortic stenosis heart murmurs.
- Ages 15 - 65
- Congenital - #1 most common cause
- Rheumatic fever - #2 most common cause
- Mitral valve prolapse - usually involved if d/t rheumatic fever
- Calcified valve
Describe the common course for aortic stenosis heart murmurs.
- Long asymptomatic period
- Rapid decline (usually around ages 50 - 60 years)
What are common associated findings with aortic stenosis murmurs?
Angina:
- 2/3 patients develop angina
- 1/2 patients also develop CAD
Syncope:
- often preceded by dizziness
- usually exertional
CHF:
- dyspnea
- rapid decline at this point
What assessment findings indicate mitral valve prolapse murmurs?
Assessment findings r/t identification:
- Systolic (in sync with carotid artery pulse)
- Click at mitral listening point:
- Initial: Midsystolic click heard at apex and left sternal border
- Later: Late diastolic click - worse with standing, quieter with squatting
What are common radiograph and EKG findings related to mitral valve prolapse murmurs?
What is the common course?
Radiograph/EKG findings:
- EKG usually normal
Course:
- most patients are asymptomatic
Name common etiologies of mitral valve prolapse murmurs.
- Degeneration of mitral valve tissue/redundancy of mitral valve leaflets
- Common in women aged 14 - 30 years
What are common associated findings with mitral valve prolapse murmurs?
Palpitations:
- PACs/PVC’s more common with exercise
Chest pain
How are aortic regurgitation murmurs identified, including assessment findings, radiograph findings, and EKG results?
Assessment findings r/t identification:
- Diastolic (not in sync with carotid artery pulse)
- Heard at aortic listening point at 2nd intercostal space at right sternal border
Radiograph - LATE finding:
- VERY large and dilated left ventricle
EKG results:
- Evidence of left ventricle hypertrophy
Name common etiologies of aortic regurgitation murmurs.
- Rheumatic heart disease
- Syphilis
- Congenital deformity
- Aortic root abnormalities
Name the common course of aortic regurgitation murmurs.
- Prolonged asymptomatic period (even with exercise)
- Late decreased exercise tolerance
- Very late CHF
What are common associated findings with aortic regurgitation murmurs?
- Angina
- CHF
- Dizziness
- Chest pain
- Wide pulse pressure
- “Water hammer pulse” = wide and quick arterial pulses
How are mitral stenosis murmurs identified, including assessment findings, radiograph findings, and EKG results?
Assessment findings r/t identification:
- Diastolic (not in sync with carotid artery pulse)
- Heard at mitral listening point at apex
Radiograph finding:
- Enlarged left atrium
EKG results:
- A-fib
Name the etiology of mitral stenosis murmurs. Describe the associated course, including average age of death.
Etiology: Rheumatic fever
Course :
Stage 1: - Long asymptomatic period of about 20 years
- Gradual reduction in exercise tolerance over about 3-5 years
Stage 2: - Onset of pulmonary congestion
Stage 3: - Development of pulmonary hypertension
Stage 4: - Severe state of low cardio output
Average age of death: 48 years
-
What are common associated and physical exam findings with mitral stenosis murmurs?
Associated findings:
- Dyspnea (most common)
- A-fib (common)
- Hemoptysis (from increased pulmonary pressure)
- Left ventricular hypertrophy
Physical exam findings:
- Loud S1
- Apical diastolic murmur radiating to axilla
