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)