Heart murmurs Flashcards
features of a normal cardiac cycle
duration ~1 second
consisting of systole and diastole
Systole is
Contraction of ventricles
ventricular pressure > atrial pressure, closing valves (mitral and tricuspid)
ventricular pressure > aortic pressure, opening valves
the closure of which valves creates S1
Mitral and tricuspid
Diastole is
relaxation of ventricles
Ventricular pressure < aortic pressure (aortic and pulmonary valves close)
Ventricular pressure < atrial pressure, opening M+T valves
passive filling begins
Atria contract to complete filling
the closure of which valves generates S2
Aortic and pulmonary
S3 occurs when?
in early diastole, caused by blood oscillating in the ventricle due to rapid filling
S4 occurs when?
before S1 in late diastole, due to blood being forced into a stiff ventricle by atrial contraction
Murmurs on which side will increase on inspiration?
Right side. increased venous return to the right atria during inspiration, which leads to an increase in stroke volume of the right ventricle during systole
List the systolic murmurs
Ejection systolic
Pansystolic
Late systolic
(during the carotid pulse, after S1)
List diastolic murmurs
Early diastolic
Mid diastolic
(after S2, not during pulse)
Ejection murmurs
S1 I<>I S2
I<>I I<>I
Early diastolic murmur
S1 S2 S1 S2
I I> I I>
Continuous murmur
S1 S2 S1 S2
Grading of murmurs
I. barely audible
II. soft, easily audible
III. moderately loud, no thrill (roughly as loud as S1/S2)
IV. loud with a thrill
V. audible with stethoscope barely on chest
VI. audible with stethoscope off
site of aortic murmurs
Aortic systolic: upper right sternal edge
Aortic diastolic: Lower left sternal edge
Ejection systolic murmurs
Harsh crescendo/decrescendo
narrowing/stenosis
loudest over aortic (usually) or pulmonary area
radiates to neck
Pan systolic murmur
Continuous blowing murmur
regurgitant valve
loudest at apex/lower left sternal edge
radiates to axilla (mitral regurg)
Late systolic murmur
(rare)
prolapse of mitral valve
opening click followed by late systolic blowing over apex
early diastolic murmur
soft, often difficult to hear
high pitched
heard over aortic area
radiates down LLSE
Mid diastolic murmur
low pitched rumbling
heard over apex with bell
heard best in lateral decubitus position in held expiration
often have a loud S1, often in AF
Mid diastolic murmur
low pitched rumbling
heard over apex with bell
heard best in lateral decubitus position in held expiration
often have a loud S1, often in AF
Valvular aortic stenosis causes
Age related calcification (commonest) Bicuspid aortic valve (young adults) supravalvular: fibrous tissue in aortic root subvalvular: fibromuscular ring radiates to carotids
Sx of AS
Angina, exertional dyspnoea, syncope, presyncope
Angina/syncope (mean survival 2 years)
HF (mean survival 1 year)
Mitral regurg
Functional MR: dilatation in IHD, LVF
degenerative mitral valve disease, old age
infective endocarditis
connective tissue disorders: SLE, Marfans
Floppy valve
Tx of MR
treat HF
diuretics
manage AF
mitral valve surgery of severe/symptomatic MR
Aortic regurg
congenital, associated with bicuspid aortic valve
valve disease: infective endoscarditis, rheumatoc, connectove tissue disorders
Aortic root disease: dissection, HTN, marfans, arthrits (e.g ank spond), psoriasis
Sx of AR
most asymptomatic as AR well tolerated. Sx of HF once LV is dilated
Mitral valve disease
MS: almost always rheumatic
dyspnoea, orthopnea, PND
Fatigue due to low CO
high risk of systemic emboli, most develop AF
