Heart Murmurs and Pulses Flashcards
Systolic Murmurs
Aortic Stenosis
Mitral Regurgitation
Diastolic Murmurs
Aortic Regurgitation
Mitral Stenosis
Slow rising pulse
Aortic Stenosis
High volume collapsing pulse
Aortic Regurgitation
Patent Ductus Arteriosus
Causes of Aortic Regurgitation
Aortic valve abnormality
Dilation of the proximal ascending aorta
Harsh pan-systolic murmur
Loudest at left lower sternal edge and inaudible at the apex
Non displaced apex
Does not intensify on inspiration
Ventricular Septal Defect
Soft late systolic murmur
At the apex, radiation to the axilla
Mitral Valve Prolapse
Slow rising pulse Non displaced, heaving apex Ejection systolic murmur Heard at right second intercostal space No radiation
Aortic Stenosis
Regular, jerky pulse
Cardiac impulse is hyper dynamic and not displaced
Mid systolic murmur, with no ejection click
Loudest at left sternal edge
Hypertrophic Cardiomyopathy
Constant “machinery like” murmur throughout systole and diastole
Patent Ductus Arteriosus
Causes of Mitral Stenosis
Rheumatic fever Congenital causes Malignant causes Systemic lupus erythematosus (SLE) Left atrial myxoma
Clinical Features of Mitral Stenosis
Palpitations
Dyspnoea
Haemoptysis
What pulse would be felt in cardiac tamponade?
Paradoxical
abnormally large decrease in SBP and pulse wave amplitude during inspiration
In what conditions might you feel a paradoxical pulse?
Left ventricular compression
Constrictive pericarditis
Severe asthma
What pulse would you feel in severe left ventricular failure?
Alternans (Alternating pulse)
Regular rhythm, alternating beats which are weak then strong
What is Takayasu’s arteritis?
Idiopathic arteritis
Typically causes narrowing of major arteries
What pulses/murmurs might be heard in Takayasu’s arteritis?
Absent pulses
Aortic regurgitation
Systolic murmurs above and below clavicle
In aortic stenosis, which symptom would confer the worst prognosis?
Syncope
Pan systolic murmur
Soft S1, Split S2
Mitral Regurgitation
Narrow pulse pressure
Aortic stenosis
Mid-late diastolic murmur (best heard on expiration Loud S1, opening snap Low volume snap Malar flush Atrial fibrillation
Mitral stenosis
What causes an S4?
Ventricular hypertrophy: Aortic Stenosis Long standing hypertension Hypertrophic cardiomyopathy Atrial contraction against a stiff ventricle
What causes an S3?
Diastolic filling of the ventricle
Considered normal if
What are the most common primary coronary tumours, and what murmur might they cause?
Atrial myxoma
Left atrial myxoma = `Loud S1, Early diastolic plop
