Heart Murmurs & Valve Disease (Exam 2) Flashcards
Define a grade 1 murmur.
very faint
Define a grade 2 murmur.
quiet but heard immediately
Define a grade 3 murmur.
moderately loud
Define a grade 4 murmur.
loud
Define a grade 5 murmur.
heard with stethoscope partly off the chest
Define a grade 6 murmur.
no stethoscope needed
What grade of murmurs are thrills associated?
Grades 4-6
What murmur(s) does a standing heart sound auscultation accentuate? Soften?
may accentuate murmurs associated with mitral valve prolapseor hypertrophic cardiomyopathy. will make murmur of aortic stenosis softer.
What does the squatting or valsalva ausculatation do in regards to murmurs?
accentuates murmur of aortic stenosis. will decrease intensity of mitral valve prolapse and hypertrophic cardiomyopathy.
What does a leaning forward heart sound ausculation do in terms of murmurs.
can be done to more clearly assess aortic and pulmonic murmurs.
Describe in relationship to systole and diastole aortic stenosis.
Flow across an abnormal SL valve or narrowed ventricular outflow tract. It is a midsystolic murmur.
What are the causes of aortic stenosis?
degnerative (age>65) bicuspid valve in the young rheumatic atherosclerosis rare (irradiation, collagen, vascular disease)
What are the symptoms of aortic stenosis?
angina-35% - half will die in 5 years
syncope-15% -half will die in 3 years
congestive heart failure-50% -half will dies in 2 years
most are asymptomatic, but once symptoms develop morbidity increases rapidly.
What is the treatment for aortic stenosis in asymptomatic patients?
no competititve athletics
mild to moderate disease, need an echo every 2-5 years
What is the treatment for aortic stenosis in symptomatic patients?
valve replacement for severe disease, if good surgical risk.
aortic stenosis with symptoms is lethal.
What are the causes of mitral valve regurgitaion/insufficiency?
Primary: leaflet, annular, or chordae/papillary muscle abnormalities
secondary: left ventricle or endocardial cushion defect, usually associated with ischemic heart disease-IHD or mitral valve proplapse or infectious endocarditis.
What are the symptoms of Mitral Valve Regurgitation/insufficiency?
frequently no symptoms exercise intolerance palpations long beore HF symptoms begin ischemic heart symptoms-angina in severe MR, high left atrial pressure cause dyspnea as left atria enlarges Afib is common
What is the Causes of Mitral stenosis?
rheumatic fever and RHD
What are the symptoms of mitral stenosis?
- subtle and slow
- significant mitral stenosis is found in pt with little or no symptoms and very few will have a clear hx of rheumatic fever
- exercise intolerance
- palpitations as MS progresses
- congestive heart failure
- hoarseness develops as left atrium impinges on the recurrent laryngeal nerve
- A fib develops in elderly
What is the management of mitral stenosis?
- yearly echo
- negative chronotropes (beta blcoker or ca+ channel blockers to decrease left atrial pressure)
- Surgical: balloon valvuloplasty for early disease and valve replacement for severe disease
- therapy for Afib
What are the causes of aortic regurgitation/insufficiency?
- Acute: chest traum or endocarditis
- Mild: bicuspid valve with severe HTN
- Severe/chronic: degeneration of valve, bicuspid valve, RHD (with mitral disease), trauma and infective endocarditis
- Rare causes: connective tissure disorder or collagen vascular disorder
What are the symptoms of aortic regurgitation/insufficiency?
- exercise intolerance
- dyspnea, othopnea
- congestive heart failure
- angina in only about 5%
- bounding periperal pulse
Describe what you would hear for aortic regurgitaion/insufficiency.
- Best heard in the 2nd or 3rd ICS at the left sternal edge
- high pitched, decrescendo, early diastolic
- blowing quality=>may be mistaken for breathing sound
- radiation: to the sternal border
What are the complications of mitral stenosis?
- as it progresses, left atrial enlargement occurs which can lead to mural thrombi, especially with A fib
- heart rate is critical in MS as HR increases, less time for diastolic ventricular filling, with leads to increased left atrial pressure which ends with pulmonary hypertension
Describe what you would hear in aortic stenosis.
- classic crescendo-decrescendo (diamond) shaped murmur
- loudest in aortic area; radiates along the carotid arteries
- A2 decreases as the stenosis worsens
Describe what you would hear in mitral valve regurgitaion/insufficiency.
- pansystolic murmur
- loudest at the left ventricular apex
- radiation reflects the direction of the regurgitant jet: to the axilla and back (flail anterior leaflet) to the base of the heart (flail posterior leaflet.
- usually associated with a systolic thrill, a soft S3
Describe what you would hear in mitral stenosis.
- mid-diastolic murmur due to atrial contraction & rapid ventricular filling
- low-pitched and best heard over the apex (w/the bell)
- little or no radiation
How does an aortic stenosis murmur fall in realtion to systole and diastole?
midsystolic-immediaely after s1 but stops halfway and doesn’t carry to s2
How does an aortic regurgitation/insufficiency murmur fall in relation to systole and diastole?
early diastolic murmur
How does a mitral stenosis murmur fall in relation to systole and diastole?
occurs in mid-diastole across AV valve
How does a mitral valve regurgitaion/insufficiency murmur fall in relation to systole and diastole?
usually is associated with a systolic thrill, a soft s3. pansystolic murmur
Define systole in terms of atrial and ventricular filling or contraction.
ventricular contraction, atrial filling
Define diastole in terms of atrial and ventricular filling or contraction
atrial contraction, ventricular filling
