Heart murmurs Flashcards
What is the murmur character of aortic stenosis?
Ejection systolic
Where is aortic stenosis best heard and where does it radiate to?
Upper right sternal edge Radiates to carotid and apex
What is the pathology of aortic stenosis?
Increased resistance between left ventricle and systemic circulation –> limited CO –> LV hypertrophy
What are the symptoms of aortic stenosis?
Dyspnoea
Syncope
Angina (coronary perfusion impaired) §
What are the signs of aortic stenosis?
- Slow rising pulse
- Narrow pulse pressure
- Heaving apex beat (pressure loaded)
- Soft or absent S2 (depending on AS severity)
- May be signs of LVF (S3, pulmonary oedema )
What are the causes of aortic stenosis? (use the pneumonic)
ABCs
A - Age (senile calcification - most common cause)
B - Bicuspid aortic valve (Turner’s syndrome)
C - Congenital
Strep-associated (rheumatic heart disease)
What is the murmur character in Aortic sclerosis?
Ejection systolic
Where is aortic sclerosis best heard and where does it radiate to?
Upper right sternal edge (does not radiate)
What is the pathology of aortic sclerosis?
Valve hard and inflexible (thickened NOT narrowed) –> Turbulence –> local sound only
What are the symptoms of aortic sclerosis?
None!
What are the signs of aortic sclerosis?
No abnormal signs - this is how you differentiate from aortic stenosis (normal pulse pressure, normal apex beat, and S2)
What are the causes of aortic sclerosis?
Senile calcification
What is the murmur character in Mitral regurgitation?
Pansystolic
Where is mitral regurgitation best heard and where does it radiate to?
Apex
radiates into the left axilla
What is the pathology of mitral regurgitation?
Backflow of blood from the left ventricle into left atrium during systole –> LV and left atrial dilation –> Pulmonary HTN
What are the symptoms of mitral regurgitation?
Dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue Palpitations
What are the signs of mitral regurgitation?
Atrial fibirillation
Displaced thrusting apex (volume -loaded)
Soft S1
Signs of pulmonary HTN (RV heave, loud P2)
May be signs of LVF (S3, pulmonary oedema)
What are the causes of mitral regurgitation ?
Papillary muscle dysfunction (post MI) Dilated cardiomyopathy Rheumatic heart disease Infective endocarditis Congenital Connective tissue disease (e.g. Marfan's)
What is the murmur character in mitral valve prolapse?
Mid-systolic click and/or late systolic murmur
differentiate from mitral regurgitation by normal S1 then gap before the murmur (hence a late systolic)
Where is mitral valve prolapse best heard and where does it radiate to? Is it louder on inspiration or expiration?
Heard loudest in the apex - radiates to the left axilla and back
What is the pathology of mitral valve prolapse?
In ventricular systole, a mitral valve leaflet prolapses int the left atrium
What are the symptoms of mitral valve prolapse?
Atypical chest pain
What are the signs of mitral valve prolapse?
Murmur only (can develop significant MR)
What are the causes of mitral valve prolapse?
Associated with: Marfan’s, PKD, Congenital heart disease, HCM, SLE, muscular dystrophy
What is the murmur character in ventricular septal defect?
Pansystolic, loud and machinery-like murmur
Where is ventricular septal defect best heard and where does it radiate to?
Lower left sternal edge
loud- radiates to the whole praecordium
What is the pathology of ventricular septal defect?
During systole, blood from the LV leaks into the RV
What are the symptoms of ventricular septal defect?
Often none if small
What are the signs of ventricular septal defect?
Signs of pulmonary HTN (RV heave, loud P2)
If acute may cause cardiogenic shock
What are the causes of ventricular septal defect?
Congenital
Complication of acute MI
What is the murmur character in tricuspid regurgitation?
Pansystolic (differentiate from mitral regurgitation by seeing if it is louder on inspiration)
Where is tricuspid regurgitation best heard and where does it radiate to?
Lower left sternal edge
What is the pathology of tricuspid regurgitation?
Blood flowing from the RV to the right atrium during systole –> increased right atrial and venous pressures
What are the symptoms of tricuspid regurgitation?
Fatigue
Hepatic pain on exertion
Ascites
Peripheral oedema
What are the signs of tricuspid regurgitation?
Giant V waves in JVP
Backflow signs (peripheral oedema, ascites, pulsatile hepatomegaly)
Signs of lung disease and pulmonary HTN (RV heave, loud P2) - if that is the cause
What are the causes of tricuspid regurgitation?
Most commonly due to RV dilation in pulmonary HTN (e.g. in chronic lung disease or left heart/valve disease)
Rheumatic heart disease
Infective endocarditis (IV drug user)
What is the murmur character in mitral stenosis?
Low- rumbling mid-diastolic murmur with opening snap
Where is mitral stenosis best heard and where does it radiate to?
Apex in left lateral position
Use bell of stethoscope
What is the pathology of mitral stenosis?
Increased resistance between left atrium and left ventricle –> high left atrial pressure –> pulmonary hypertension
What are the symptoms of mitral stenosis?
Dyspnoea
Fatigue
Haemoptysis
Chest pain
What are the signs of mitral stenosis?
Malar flush (due to low cardiac output) Atrial fibrillation Tapping apex (palpable S1) Loud S1 Signs of pulmonary HTN ( RV heave, loud P2)
What are the causes of mitral stenosis?
Rheumatic heart disease
other causes are rare (congenital, carcinoid)
What is the murmur character in mitral stenosis?
Early diastolic (sounds like a breath)
Where is mitral stenosis best heard and where does it radiate to?
Upper right sternal edge or lower left sternal edge if sitting forwards
What is the pathology of mitral stenosis?
Regurgitation of blood from aorta back into the LV during diastole –> increased LV end-diastolic volume
What are the symptoms of mitral stenosis?
Fatigue
SOB
Palpitations
What are the signs of mitral stenosis?
Collapsing pulse
Wide pulse pressure
Very displaced thrusting apex (volume-loaded)
Backflow signs:
- Corrigan’s (visible carotid pulsation)
- de Musset’s (head-nodding pulse)
- Quincke’s (red-coloured-pulsation in nails)
+/- Austin Flint murmur (apical diastolic rumble)
What are the causes of mitral stenosis?
Acute causes: 1. infective endocarditis 2. aortic dissection Chronic causes: 1. Connective tissue disease (e.g. Marfan's, ankylosing spondylitis) 2. Rheumatic heat disease
