Heart Murmurs Flashcards
what causes 1st heart sound (S1)
Closing of the atrioventricular valves - triscupid + mitral valves
- this is start of systole
what causes 2nd heart sound (S2)
closing of semilunar valves - pulmonary + aortic
- this is start of diastole
what does a 3rd heart sound indicate in
- a young healthy person (15- 40 years)
- older patient
normal in young, healthy individuals
3rd heart sound heard in HF in older individuals
what causes a 4th heart sound?
turbulent blood flow against a stiff/ hypertrophic ventricle
- heard directly before S1
- always pathological
most common heart murmur
aortic stenosis
triad of symptoms in aortic stenosis
syncope, angina, dyspnoea on exertion
what type of murmur is aortic stenosis
ejection systolic murmur
where is aortic stenosis best heard? where does it radiate to?
aortic area, radiates to carotids
what causes aortic stenosis in the elderly?
degenerative calcification
what causes aortic stenosis in younger patients? <65 years
congenital bicuspid valve
slow rising pulse + narrow pulse pressure is seen with which heart murmur
aortic stenosis
what might happen to the heart sounds in aortic stenosis
quiet S2
may have 4th heart sound
what investigation is definitive for valvular disease
echo- transthoracic or trans oesophageal
management of aortic stenosis if asymptomatic
observe + modify cardiac risk factors 6 monthly echo
management of aortic stenosis if severe + symptomatic and fit for surgery
surgical aortic valve replacement (SAVR)
- mechanical valve: last longer but require anti-coagulation
- bioprosthesis: fail sooner but only require 3 months aspirin
management of aortic stenosis if severe + symptomatic but not fit for surgery
TAVI (transcatheter aortic valve implantation)
Balloon valvuloplasty - temporary relief (6-12 months), used as bridge to TAVI in unstable patients
summary of symptoms / signs in aortic stenosis
ejection systolic murmur
symptoms: chest pain, dyspnoea, syncope
narrow pulse pressure
slow rising pulse
soft / abscent S2
features of aortic regurgitation
early diastolic murmur best heart at apex
collapsing pulse
wide pulse pressure
causes of aortic regurgitation
idiopathic age related weakness
connective tissue disorders e.g. Ehlers Danlos, Marfans
mid diastolic rumbling murmur with loud S1 ‘ opening snap’
mitral stenosis
what causes mitral stenosis
rheumatic fever
which murmur has a tapping apex beat
mitral stenosis
features of mitral stenosis
mid diastolic rumbling murmur
loud S1, ‘opening snap’
tapping apex beat
malar flush
AF
pansystolic blowing murmur that radiates to axilla
mitral regurgitation
causes of mitral regurgitation
weakening of valve with age
ischaemic heart disease
infective endocarditis
rhuematic heart disease
ehlers danlos / marfans
what murmurs can be ejection systolic
aortic stenosis
pulmonary stenosis
what murmurs can be pansystolic
mitral regurgitation
tricuspid regurgitation
which murmur is associated with AF
Mitral stenosis
