Heart Murmurs Flashcards
What is longer systole or diastole?
Diastole
What causes the first and second heart sounds?
first heart sound- closing of the AV valves (mitral and tricuspid)
Second heart sound- closing on the semilunar valves (Pulmonary and Aortic)
How many cusps does the aortic valve have?
3 cusps
What is the pathology of Aortic Stenosis?
The aortic valve is narrowed, the velocity of blood over the valve increases, as ventricles are to generate more pressure to open aortic valve. This difference = pressure gradient. The higher the pressure gradient the more severe the Aortic Stenosis. This is a PRESSURE OVERLOAD and results in the thickening of the wall of the LV hypertrophy.
Name some causes of Aortic Stenosis ?
Degeneration (due to AGE), bicuspid valve, Rheumatic Fever
What would the physical findings in Aortic Stenosis be?
slow-rising pulses, heart murmur, shift in apex beat, cardiomegaly due to hypertrophy (can see on ECG) due to pressure overload.
Describe the murmur heard in Aortic Stenosis?
Ejection systolic murmur (crescendo, decrescendo) , can radiate to the carotids. Best heard at the base (top of the heart) at right sternal edge . ‘Whoosh’ sound
What is isometric contraction?
No change in volume but change in pressure. Pressure in ventricles increases to exceed that in aorta.
What are the symptoms of Aortic Stenosis?
SOB, Angina, Syncope, can be asymptomatic
What is the treatment of Aortic Stenosis?
Aortic Valve replacement, TAVI ( trans-aortic valve replacement.
What is the pathology of Mitral Regurg?
The mitral valve is not functioning properly and doesn’t shut properly. Blood from LV to LA. This blood the back to LV. So LA and LV have volume overload. This causes dilation of chambers
What are some causes of Mitral Regurg?
Mitral Valve prolaspe (Barlow’s disease), Ischemic Mitral Regurg , Rheumatic Fever, Endocarditis, congenital defects
What are symptoms of Mitral Regurg?
SOB on exertion and lying down, often get AF
What is the murmur heard in Mitral Regurg?
Pansystolic murmur, heard throughout systole. Heard best in mitral area.
Sounds similar to AS but heard loudest in mitral area
What is the ejection fraction?
volume of blood that leaves the LV compared with the total volume of blood in the ventricle.
SV (COx HR) divided by End diastolic volume
What does volume overload and pressure overload pathologies cause?
Volume overload- Dilation
Pressure overload- Hypertrophy
What is the treatment of Mitral regurg?
Mitral valve replacement (mechanical (metal)/ prosthetic (tissue)
Mechanical valve have to be on warfain but lasts ling than prosthetic valve
Mitral valve repair
Would wouldn’t you want to give a mechanical valve to?
Wouldn’t give to patient with bleeding tendencies
Not to a woman of child-bearing age, as warafin can damage the foetus.
What are the two main systolic murmurs?
- Aortic Stenosis
- Mitral regurg
ASMR
What happens in Pulmonary stenosis?
Think about Aortic Stenosis. Same pathology but on opposite side of the heart.
RV hypertrophy.
Pressure overload.
Ejection systolic on L sternal edge
What happens in tricuspid regurg?
Think about Mitral Regurg, same pathology but on opposite side of heart.
RA and RV dilation
Volume overload.
What brings out a left sided and a right sided murmur?
All Left sided murmurs heard better on inspiration
All Right sided murmurs heard better on expiration
What is the pathology of Mitral Stenosis?
Mitral valve is stenosed, blood have to push harder to get into LV
Pressure overload
Hypertrophy- effects LA
What is the main cause of Mitral Stenosis?
RHUEMATIC FEVER !!
what murmur do you hear in Mitral Stenosis?
Mid-diastolic rumbling murmur, best heard at apex of heart in the mitral area.
Low pitched murmur
Loud first heart sound
What is the treatment for Mitral stenosis?
Mitral valve replacement
Mitral valve balloon valvoplasty
What is the pathology of Aortic Regurg?
Some blood comes back into LV due to defective aortic valve.
What some causes of Aortic Regurg?
Rheumatic fever, high blood pressure, age
Is aortic regurg a high volume or high pressure condition?
High Volume so get a high volume, collasping pulse
what murmur do you hear in Aortic Regurg ?
Mid-diastolic ‘blowing’ murmur , beast heart LEFT sternal edge.
