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Cardio > Heart Murmurs > Flashcards

Heart Murmurs Flashcards

1
Q

What are the causes of aortic stenosis?

A

Senile calcification
Bicuspid aortic valve
Rheumatic heart disease

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2
Q

What is the presentation of aortic stenosis?

A

Usually asymptomatic

When symptomatic, start to worry. Symptoms are: chest pain, SOB, syncope. This is due to decreased CO.

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3
Q

What are the signs of aortic stenosis?

A 
Slow rising pulse
Narrow pulse pressure 
Crescendo-decrescendo
Ejection SYSTOLIC murmur 
High pitched

Most commonly heard in the second intercostal space

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4
Q

What is the management of aortic stenosis?

A

If asymptomatic, observe the patient
If symptomatic and stable: valve replacement
If symptomatic and unstable: balloon valvuloplasty

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5
Q

What medication is contra-indicated in aortic stenosis?

A

Nitrates

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6
Q

What are the signs of aortic regurgitation?

A 
Diastolic murmur (heard best in expiration when patient is sat forward) 
Collapsing pulse (Water-hammer or Corrigan's or de Musset's pulse)
Wide pulse pressure

In severe AR, Austin-Flint murmur will be heard (regurgitation hits against the mitral valve causing a mitral stenosis)

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7
Q

What are the causes of aortic regurgitation?

A

Due to valve dysfunction: rheumatic fever, bicuspid aortic valve, infective endocarditis

Due to aortic root disease: Marfan’s, Ehlers-Danlos, hypertension, aortic dissection

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8
Q

What are the complications of aortic stenosis, mitral stenosis, aortic regurgitation and mitral regurgitation?

A

Aortic and mitral stenosis: left ventricular/left atrial hypertrophy

Aortic and mitral regurgitation: left ventricular dilatation/left atrial dilatation

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9
Q

What is the management of aortic regurgitation?

A

Reduce systolic hypertension

ACE-i. Echo every 6-12 months.

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10
Q

What are the causes of mitral stenosis?

A

RHEUMATIC FEVER

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11
Q

What is mitral stenosis?

What is the presentation of mitral stenosis?

A

Narrowing of mitral valve, so there is a struggle to push blood through to the left ventricle.

SOB, haemoptysis
Hoarseness (pressure on recurrent laryngeal nerve)
Dysphagia (oesophagus)
Bronchial obstruction

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12
Q

What are the signs of mitral stenosis?

A

Diastolic murmur (best heard in expiration while patient is lying on left)
Loud S1, opening snap
Malar flush on cheeks
AF (due to enlarged left atrium)

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13
Q

What do tests show in mitral stenosis?

A

Possible AF
On CXR, left atrial enlargement (double shadow in right cardiac silhouette)
Pulmonary oedema

Echo is diagnostic

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14
Q

What are the indications for cardiac catheterization for mitral stenosis?

A

Previous valvotomy
Angina
Severe pulmonary hypertension
Calcified mitral valve

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15
Q

What is the management of mitral stenosis?

A

If in AF: RATE CONTROL and anticoagulate with warfarin.

If this fails to control symptoms, balloon valvuloplasty.

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16
Q

What makes a mitral stenosis murmur louder?

A

After a Valsalva manouvre
After exercise
Squatting/hand gripping

17
Q

What is the main complication of mitral regurgitation?

A

Congestive heart failure

18
Q

What are the two most common heart murmurs?

A

1) Aortic stenosis

2) Mitral regurgitation

19
Q

What are the signs of mitral regurgitation?

A

Pansystolic murmur ‘blowing’. Best heard at the apex and it radiates to the axilla.
Soft S1 and split S2 may occur.

20
Q

What may tests show in mitral regurgitation?

A

Broad P wave (atrial enlargement)

Cardiomegaly may be seen

21
Q

What is the management of mitral regurgitation?

A

Increase CO: nitrates, diuretics, positive inotropes, intra-aortic balloon pump
If in heart failure, ACE inhibitors may be considered alongside beta blockers and spironolactone

22
Q

How does a mitral valve prolapse present?

A

Inferior T wave inversion
Mid systolic click/late systolic murmur
Atypical chest pain, palpitations, autonomic dysfunction symptoms.

23
Q

In an examination, how do you assess a murmur properly?

A 
Use 'SCRIPT'
Site: where is it loudest?
Character: soft/blowing/crescendo/decrescendo
Radiation
Intensity: what grade is the murmur?
Pitch: high/low/grumbling
Timing: systolic or diastolic
24
Q

What is the grading of murmurs?

A

Use the Levine scale

1) Difficult to hear
2) Quiet
3) Easy to hear
4) Easy to hear with a palpable thrill
5) Can hear with a stethoscope barely touching the chest
6) Can hear with a stethoscope off the chest

25
Q

What does a third heart sound present as?

A

Normal in younger patients, pregnancy and in athletes

Sounds like ‘Ken-tucky’. There is a gap after S2.

May signify heart failure, cardiomyopathy, or severe regurgitation.
Should only be heard with a bell.

26
Q

Which patients are at increased risk of developing infective endocarditis?

A 
Acquired valvular disease
Valve replacement
Structural congenital heart disease
Previous infective endocarditis
Hypertrophic cardiomyopathy

Cardio (10 decks)

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