Heart murmurs Flashcards
What is a third heart sound?
Rapid ventricular filling causes the chords in the ventricle to pull, and then twang (like a guitar)
What can S3 indicate?
Heart failure (but can be normal in young people)
When is the third heart sound heard?
Just after the second heart sound
When is the fourth heart sound heard?
Just before the first heart sound
What does a fourth heart sound indicate?
Stiff/ hypertrophic ventricles
What are we hearing with the fourth heart sound?
Turbulent flow into the ventricle, caused by the filling of a non-compliant ventricle
What types of valvular pathologies cause hypertrophy of the heart?
Stenosis
- Mitral stenosis causes left atrial hypertrophy
- Aortic stenosis causes left ventricular hypertrophy
What types of valvular pathologies cause heart dilatation?
Regurgitation
- Mitral regurgitation causes left atrial dilatation
- Aortic regurgitation causes left ventricular regurgitation
What are the causes of mitral stenosis?
Rheumatic fever
Endocarditis
What murmur is heard in mitral stenosis?
Mid-diastolic, low pitched rumbling
What else is heard in mitral stenosis?
Loud S1 - hypertrophied valve is loud to shut
What face sign is associated with mitral stenosis?
Malar flush
What arrhythmia is mitral stenosis associated with?
Atrial fibrillation
What type of murmur is heard in mitral regurgitation
Pan-systolic with high pitched whistling
What condition is mitral regurgitation associated with?
Congestive cardiac failure
Where does mitral regurgitation radiate to?
Axilla
What are the causes of mitral regurgitation?
Idiopathic weakening of valve
Ischaemic heart disease
Endocarditis
Rheumatic heart disease
Connective tissue disorders
What is the most common valvular disease?
Aortic stenosis
What kind of murmur is heard in aortic stenosis?
Ejection systolic murmur
- High pitched
- Crescendo-decrescendo
Where does aortic stenosis radiate?
Carotids
What other features are present in aortic stenosis?
Slow rising pulse
Narrow pulse pressure
What are the causes of aortic stenosis?
Idiopathic age related calcification
Rheumatic heart disease
What type of murmur does aortic regurgitation cause?
Early diastolic murmur
What type of pulse is associated with aortic regurgitation?
Collapsing pulse
