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Cardiology > Heart Murmurs > Flashcards

Heart Murmurs Flashcards

1
Q

What is a heart murmur?

A

A heart murmur is the sound produced when blood flowing through the heart is turbulent

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2
Q

Causes of heart murmurs

A

1) Blood flowing through an abnormal narrowing (e.g. aortic stenosis, mitral stenosis, pulmonary stenosis).
2) Blood flowing in the wrong direction through the heart, and mixing with blood flowing in the normal direction (e.g. mitral regurgitation, tricuspid regurgitation).
3) An abnormal connection between two different parts of the heart (e.g. atrial septal defect, patent ductus arteriosus
4)
Blood flowing faster through the heart (e.g. functional murmurs in sepsis and thyrotoxicosis).

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3
Q

What happens in systole?

A

1) ventricular contraction
2) opening of pulmonary and aortic valve.
3) closing of mitral and tricuspid valve

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4
Q

What happens in diastole

A

1) early diastole- ventricular and atria relax
2)aortic and pulmonary valve closes
3)atria contract
4 opening of mitral and tricuspid valve

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5
Q

What happens during first heart sounds

A
  • start of systole
  • closing of mitral and pulmonary valve
  • peripheral pulse
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6
Q

What happens during 2nd heart sound?

A
  • end of systole, start of diastole
  • closure of aortic and pulmonary valve.
  • pulmonary valve may close after aortic valve, especially after inspiration ie more blood volume into right ventricle
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7
Q

What murmurs can be heard during systole?

A
  • aortic stenosis
  • pulmonary stenosis
  • mitral regurgitation
  • tricuspid regurgitation
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8
Q

What murmurs can be heard during early diastole?

A
  • aortic and pulmonary regurgitation
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9
Q

What murmurs can be heard during mid or late diastole?

A
  • mitral and tricuspid stenosis
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10
Q

What causes a systolic murmur?

A
  • aortic and pulmonary stenosis
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11
Q

What causes a pansystolic murmur?

A
  • mitral and tricuspid regurgitation
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12
Q

Aortic stenosis vs aortic sclerosis vs HOCM

A
  • ejection systolic murmur
  • loudest at aortic region
  • does not radiate to carotids except aortic stenosis
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13
Q

What murmur heard loudest on inspiration?

A
  • tricuspid and pulmonary valves ( stenosis or regurgitation)
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14
Q

What murmur heard loudest on expiration?

A
  • aortic and mitral valve
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15
Q

Where does the murmur radiate?

A
  • AS : carotids
  • AR : radiates to left sternum
  • MR : axilla
  • pulmonary stenosis: left shoulder or infraclavicular region
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16
Q

Clinical features of aortic stenosis

A
  • Ejection systolic murmur
  • Heard loudest over the aortic area
  • Radiates to the carotid arteries
  • Loudest on expiration and when the patient is sitting forwards
  • Slow rising pulse with narrow pulse pressure
  • Non-displaced, heaving apex beat (if present indicates left ventricular hypertrophy)
17
Q

Causes of AS

A
  • senile calcification

- bicuspid aortic valve

18
Q

Clinical feature of MR

A
  • Pansystolic murmur
  • Heard loudest over mitral area
  • Radiates to axilla
  • Heard loudest using the bell of the stethoscope
  • Loudest on expiration in the left lateral decubitus position
  • Displaced, hyperdynamic apex beat
19
Q

Causes of MR

A
  • degenerative
  • left ventricular dilatation
  • IE
  • rheumatic heart disease
  • ruptured chordae tendinae
  • connective tissue disorder
20
Q

Clinical features of AR

A

-Decrescendo early diastolic murmur
-Heard loudest at left sternal edge (the direction that the turbulent blood flows) – sometimes heard loudest over the aortic area
-Collapsing pulse (i.e. water hammer pulse with wide pulse pressure)
-Displaced, hyperdynamic apex beat
-Austin Flint murmur:
Low pitched rumbling mid-diastolic murmur heard best at the apex
Caused by the regurgitated blood through the aortic valve mixing with blood from the left atrium, during atrial contraction
A sign of severe aortic regurgitation

21
Q

Causes of AR

A
  • IE
  • Connective tissue disorder
  • Rheumatolgy disorder - SLE, Ank Spod, RA
22
Q

Clinical feature of MS

A
  • Low-pitched, rumbling mid-diastolic murmur with an opening click (click heard in mid-diastole when the mitral valve opens)
  • Heard loudest over the apex
  • Loudest in left lateral decubitus position on expiration
  • A low-volume pulse which may be irregularly, irregular (atrial fibrillation is common in mitral stenosis)
  • Loud first heart sound with tapping apex beat (due to a palpable closing of the mitral valve)
23
Q

What can MS lead to due to high atrial pressure?

A
  • pulmonary HTN

- signs ; malar flush, heaves

24
Q

Cause of MS

A
  • rheumatic heart disease ( most common )
  • congenital
  • connective tissue disorder
25
Q

Clinical features of tricuspid regurgitation?

A 
Pansystolic murmur
Heard loudest over the tricuspid region
Loudest during inspiration
Large ‘v-waves’ visible in the jugular veins – caused by the right atrial filling of blood against a closed tricuspid valve
Visible/palpable hepatic pulsations
Signs of right-sided heart failure:
Right ventricular heave
Peripheral oedema
Hepatomegaly
Ascites
26
Q

Causes of TR

A
  • dilated right ventricle ( secondary to pulmonary HTN )
  • RHD
  • IE ; IVDU commonly affects tricuspid valve
27
Q

Clinical feature of PS?

A 
Ejection systolic murmur
Heard loudest over pulmonary area
Loudest during inspiration
Radiates to left shoulder/left infraclavicular region
Prominent ‘a waves’ in the jugular veins
28
Q

HOCM

  • pathophysiology
  • inheritance
  • poor prognosis
  • mx
A
  • septal hypertrophy (concentric hypertrophy)
  • AD
  • worsening septum thickening on echo (>3cm), young age, fhx of death, VT on holter,
  • ICD
29
Q

Complication post PCI

A
  • stent thrombosis due to platelete aggregation (thts y you give dual antiplatelete), presents as acute MI, within first month
  • restenonsis due to excessive tissue proliferation around stent, angina sx, 3-6mths
30
Q

WPW associations

A
  • mital valve prolapse
  • HOCM
  • ebstein anomaly
  • thyrotoxicosis
31
Q

Mx for AS

A
  • asymtomatic observe
  • symptomatic valve replacement
  • gradient > 40mmHG with LVSS ; valve replacement
32
Q

Target BP in diabetics

- first line anti HTN

A
  • 140/90

- ace inhibitor ( also renal protective )

33
Q

Angina treatment

  • first line
  • c/i
A
  • b blocker

- verapamil / CCB ; may leas to heart block!!!

34
Q

Takasayu arteritis

  • common affect, sign
  • assc
  • mx
A
  • large vessel arteritis
  • aorta occlusion, absent limb pulse
  • renal artery stenosis
  • steroids

Cardiology (3 decks)

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