Heart Murmurs Flashcards
PC AS
SAD
Features AS
Ejection systolic 1-6 Aortic - Crescendo-decrescendo Carotids Systemic
Systemic AS
4th HS quiet S2 Heaving apex Ejection click Slow rising pulse Narrow pulse pressure
ECG AS
LVH / LV strain pattern
CXR AS
NA
DDX AS
Aortic sclerosis
HOCM
PS
MR
Surgical treatment AS
Symptomatic- prognosis 3 years
A symptomatic with gradient > 50mmHg
Valvuloplasty if unfit for surgery
Causes of AR
RHD
IE
SYPHILIS
Bicuspid
HTN
AD
Marfans
RA
Ank spon
PC AR
SOB
Fatigue
Palpitations
Features of AR
Early diastolic 1-4 LLSE sitting up and exp Breath like high pitch blowing - Systemic
Systemic features of AR
4
S3 Thrusting, displaced Collapsing pulse Wide pulse pressure 5 signs
5 signs of AR
Corrigans Quinke DeMusset Duroziez Troubes
Corrigans
Exaggerated carotid
Quinke
Pulsating nail bed
DeMusset
Heading nodding
Duroziez
Diastolic femoral murmur
Troubes
Pistol shot femorals
CXR AR
Cardiomegaly
Heart failure
DDX AR
PR
Graham Steele
Treatment AR
Diuretics
Vasodilators
Surgery AR
More than mild disease
DONT WAIT UNTIL IRREVERSIBLE
MS Causes
Rheumatic heart disease
PC MS
SOB Fatigue Pulmonary oedema Haemoptysis RHF
Features of MS
Mid- diastolic 1-4 Apex On LHS exp Rumbling low pitched - Systemic
Systemic features of MS
6
Opening snap Tapping apex A fib LOUD S1 Mitral facies Signs RHF
ECG MS
A fib (irregular r r, narrow QRS, no P waves) P mitrale= bifid P waves
CXR MS
Large LA
Pulmonary venous congestion
DDX MS
Austin flint (severe AR) Carey Coombs (rheumatic fever) TS (usually rheumatic)
Treatment of MS
A fib treatment and anti coagulation
Diuretics
Surgery MS
Valvuloplasty- more than mild Valve replacement/ repair - associated MR - rigid, calcified - persistent LA thrombus
Causes of MR
7
RHD
IE
MVP
Post MI pap rupture
LV dilation
Marfans
SLE
PC MR
SOB
FATIGUE
other LVF
Features of MR
Pan systolic 1-6 Apex - Blowing Axilla Systemic
Systemic features of MR
S3 gallop- quiet S1, obliterated S2
Thrusting, displaced
A fib
Audible click in valve prolapse
ECG MR
A fib
VEBS
CXR MR
Cardiomegaly (late)
Cardiac failure
Differential MR
VSF (esp post mi)
TR
AS
Treatment MR
A fib and anticoagulant
Diuretics
ACE inhibitors – since HTN worsens MR
Surgery MR
More than mild
LV dysfunction
DONT WAIT IRREVERSIBLE
Grade 1 murmur
Very faint, just audible, EXPERT optimal
Grade 2 murmur
Quiet, just audible- non expert optimal
Grade 3 murmur
Moderately loud
Grade 4 murmur
LOUD + palpable thrill
Grade 5 murmur
VERY LOUD + thrill + hear off chest with stethoscope
Grade 6 murmur
VERY LOUD + thrill + hear without stethoscope
Aortic sclerosis
A symptomatic Doesn't radiate to carotids No slow rising pulse Normal pulse pressure S2= normal, loud
Indications prosthetic valve
Elderly
Can’t use warfarin– pregnant/ case by case
6 complications of prosthetic valves
Structural valve failure Para valvular leak Thrombus/ obstruction IE intra vascular haemolysis (Warfarin related)
Causes of AS
RHD
Ca bicuspid- 50-60
Ca tricuspid- 70+
