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General med - Cardiovascular > Heart murmurs and sounds > Flashcards

Heart murmurs and sounds Flashcards

1
Q

What is S1 caused by and what does it indicate?

A

Closure of mitral and tricuspid valves

Marks the start of ventricular systole

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2
Q

What is S2 caused by and what does it indicate?

A

Closure of aortic and pulmonary valves

Marks end of ventricular systole and the start of diastole

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3
Q

Why is S2 not always heard as one discrete sound and sometimes split?

A

Pulmonary valve may close just after aortic valve

Closure of pulmonary valve just after the aortic valve is prolonged during inspiration, or in defects which cause more blood to be pumped out of the right ventricle

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4
Q

What is a thrill?

A

Palpable vibration caused by turbulent blood flow through a heart valve

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5
Q

Murmur associated with aortic stenosis and where is it loudest

A

Ejection systolic murmur
‘Crescendo-decrescendo’
Radiates to carotid arteries

Heard loudest over aortic valve

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6
Q

Causes of aortic stenosis

A

Calcification of aortic valves(most common)

Congenital abnormality of aortic valve(bicuspid aortic valve)

Rheumatic heart disease(rare)

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7
Q

Clinical features of aortic stenosis not linked to murmur

A

Slow rising pulse with narrow pulse pressure

Non-displaced, heaving apex beat(indicates LVH)

Reduced or absent S2

Reverse splitting of S2

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8
Q

Murmur associated with mitral regurg

A

Pansystolic murmur heard loudest over mitral area and radiates to the axilla

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9
Q

Causes of mitral regurg

A 
Infective endocarditis 
Acute MI with rupture of papillary muscles 
Rheumatic heart disease 
Congenital defects of mitral valve 
Cardiomyopathy
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10
Q

Clinical features of mitral regurg

A

Heard loudest using the bell of the stethoscope
Loudest on expiration in the left lateral decubitus position
Displaced, hyperdynamic apex beat

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11
Q

Murmur associated with aortic regurgitation

A

Decrescendo early diastolic murmur heard loudest at left sternal edge

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12
Q

Causes of aortic regurg linked to valve pathology

A

Congenital bicuspid aortic valve
Rheumatic heart disease
Infective endocarditis

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13
Q

Causes of aortic regurg linked to aortic root dilatation

A

Aortic dissection
Connective tissue diseases(e.g. marfan’s)
Aortitis

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14
Q

Clinical features associated with aortic regurg

A

Austin flint murmur
Collapsing pulse
Displaced, hyperdynamic apex beat

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15
Q

What is an Austin Flint murmur

A

Low pitched rumbling mid-diastolic murmur at apex

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16
Q

What is an austin flint murmur caused by

A

Caused by regurgitated blood through the aortic valve mixing with blood from left atrium during atrial contraction

Sign of severe aortic regurg

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17
Q

Murmur associated with mitral stenosis

A

Associated with a low-pitched, rumbling, mid-diastolic murmur heard loudest over the apex

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18
Q

Causes of mitral stenosis

A

Rheumatic heart disease(most common)

Congenital

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19
Q

Clinical features of mitral stenosis

A

Loudest in left lateral decubitus position on expiration
Low-volume pulse
Loud first heart sound with tapping apex beat
Malar flush

20
Q

Arrhythmia associated with mitral stenosis

A

Atrial fibrillation

21
Q

Murmur associated with mitral valve prolapse

A

Associated with a combination of a mid-systolic click and mid to late-systolic murmur

22
Q

What is primary mitral valve prolapse caused by

A

Myxomatous degeneration of the mitral valve and is associated with connective tissue diseases

23
Q

Murmur associated with tricuspid regurg

A

Pansystolic murmur heard loudest over the tricuspid region

24
Q

Causes of tricuspid regurg

A 
Right ventricular dilatation 
Rheumatic fever 
Infective endocarditis 
Carcinoid syndrome 
Congenital(ASD, Ebstein)
25
Q

What is the ebstein anomaly

A

Abnormal attachment of tricuspid valve leaflets which causes the tricuspid valve to displace downwards into the right ventricle

26
Q

Clinical features of tricuspid regurg

A

Large ‘v-waves’ visible in the jugular veins(caused by right atrial filling against a closed tricuspid valve)

Visible/palpable hepatic pulsations

Signs of right-sided heart failure

27
Q

Signs of right-sided heart failure

A

Right ventricular heave
Peripheral oedema
Hepatomegaly
Ascites

28
Q

Murmur associated with pulmonary stenosis

A

Ejection systolic murmur heard loudest over pulmonary area

Radiates to left shoulder/left infraclavicular region

29
Q

Causes of pulmonary stenosis

A

Congenital
Rheumatic fever
Carcinoid syndrome

30
Q

Congenital causes of pulmonary stenosis

A

Turner’s
Noonan’s
Williams
Tetralogy of fallot

31
Q

Clinical features of pulmonary stenosis

A

Prominent ‘a waves’ in jugular veins
Widely split S2
Right ventricular dilatation may lead to signs of right-sided heart failure

32
Q

Clinical features of pulmonary regurg

A

Early decrescendo murmur heard loudest over the left sternal edge

Loudest during inspiration

Usually due to pulmonary hypertension(graham steell murmur)

33
Q

Causes of pulmonary regurgitation

A

Pulmonary hypertension
Infective endocarditis
Congenital valvular heart disease

34
Q

Murmur associated with tricuspid stenosis

A

Soft diastolic murmur loudest at 3rd-5th intercostal space at the left sternal edge

35
Q

Causes of tricuspid stenosis

A 
Rheumatic fever(most common) 
Congenital disease 
Infective endocarditis
36
Q

Clinical features of tricuspid stenosis

A

Raised JVP with giant ‘a waves’
Peripheral oedema
Ascites

37
Q

What are congenital VSDs often associated with

A

chromosomal disorders:

Down’s syndrome
Edward’s syndrome
Patau syndrome
cri-du-chat syndrome

38
Q

Acquired cause of VSD

A

Post MI

39
Q

Post-natal VSD presentation

A

failure to thrive

features of heart failure
hepatomegaly
tachypnoea
tachycardia
pallor

classically a pan-systolic murmur which is louder in smaller defects

40
Q

Mx of VSD

A

small VSDs which are asymptomatic often close spontaneously are simply require monitoring

moderate to large VSDs usually result in a degree of heart failure in the first few months
nutritional support
medication for heart failure e.g. diuretics
surgical closure of the defect

41
Q

Complications of VSD

A 
Aortic regurgitation
Infective endocarditis 
Eisenmger's complex 
Right heart failure 
Pulmonary hypertension
42
Q

What is coarctation of the aorta

A

Congenital narrowing of the descending aorta

43
Q

Features of aortic coarctation

A

infancy: heart failure
adult: hypertension
radio-femoral delay
apical click from the aortic valve
notching of the inferior border of the ribs (due to collateral vessels) is not seen in young children

44
Q

Murmur associated with aortic coarctation

A

Mid systolic murmur, maximal over back

45
Q

Aortic coarctation associations

A

Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis

46
Q

What might be seen on CXR in mitral stenosis

A

Left atrial enlargement

47
Q

What is a corrigan pulse/water-hammer pulse

A

Pulse that is forceful and then suddenly collapses usually found in patients with aortic regurg

General med - Cardiovascular (13 decks)

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