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1. Cardiovascular > Heart Sounds and Valvular Disease > Flashcards

Heart Sounds and Valvular Disease Flashcards

1
Q

What causes the first heart sound?

A

Beginning of systole - closure of the mitral and tricuspid valves

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2
Q

What causes the second heart sound?

A

Beginning of diastole - closure of aortic and pulmonary valves

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3
Q

What do systolic murmurs coincide with?

A

Carotid pulse

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4
Q

What do diastolic murmurs not coincide with?

A

Carotid pulse

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5
Q

What is physiological splitting of the 2nd heart sound caused by?

A
  • inspiration causes a drop in interthoracic pressure
  • this results in increased venous return to the right side of the heart
  • right ventricular ejection time increased
  • hence, pulmonary component of 2nd heart sound may be delayed
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6
Q

What causes a third heart sound?

A

Early diastolic low frequency filling sound immediately after the 2nd sound
-heard best at the apex

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7
Q

When is a third heart sound normal?

A

child or young adult with no cardiac disease

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8
Q

When is a third heart sound not normal (pathological)?

A

older patient with suspected or known cardiac disease

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9
Q

What causes a fourth heart sound?

A

late diastolic low frequency filling sound before the first heart sound

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10
Q

What is a fourth heart sound due to?

A

atrial contraction causing rapid blood flow into stiff ventricles

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11
Q

What diseases can cause a fourth heart sound?

A

aortic stenosis
hypertension
myocardial ischaemia

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12
Q

What is the third heart sound due to?

A

acceleration and deceleration of blood during early passive filling of the ventricle

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13
Q

What causes an innnocent murmur?

A

Turbulent flow in the right ventricular outflow tract

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14
Q

What are the characteristics of an innocent murmur?

A
  • localised to one auscultatory area (normally pulmonary)
  • no other cardiac abnormalities
  • soft mid systolic
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15
Q

Name the two types of systolic murmurs?

A

Pansystolic – mitral regurgitation, same loudness between the 1st and 2nd heart sound
Ejection systolic – aortic stenosis, crescendo between the 1st and 2nd sound

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16
Q

Name the two types of diastolic murmurs?

A

Early diastolic – aortic regurgitation, early crescendo after 2nd sound
Mid diastolic – mitral stenosis, heard just before the 1st sound

17
Q

What type of murmur is mitral stenosis?

A

diastolic

18
Q

What type of murmur is mitral regurgitation?

A

systolic

19
Q

What type of murmur is aortic stenosis?

A

systolic

20
Q

What type of murmur is aortic regurgitation?

A

diastolic

21
Q

At what murmur grade can you palpate a thrill?

A

grade 4

22
Q

Name some causes of aortic stenosis?

A

Degenerative (age related)
Congenital e.g. bicuspid valve (instead of having 3 valve leaflets they have 2)
Rheumatic fever

23
Q

Name some symptoms of aortic stenosis?

A

Breathlessness
Chest pain – mimics angina chest pain
Dizziness/syncope

24
Q

Describe the treatment of aortic stenosis?

A

Conventional valve replacement - mechanical or bioprosthetic
Trans catheter aortic valve replacement (TAVI)
Balloon Aortic valvotomy (BAV)

25
Q

What are the clinical signs of aortic stenosis?

A

Low volume pulse
Forceful displaced apex – heart is pumping against big resistance
Ejection systolic murmur that can radiate to the carotids

26
Q

What are the causes of mitral regurgitation?

A 
Leaflets
-	Prolapse
-	Rheumatic
-	Myxomatous (floppy)
-	Endocarditis
Chordae rupture (degenerative)
-	Prolapse/flail leaflet
Papillary muscles rupture
-	Ischaemic
Annular dilatation 
-	Functional
27
Q

What are the symptoms of mitral regurgitation?

A

Breathlessness
Peripheral oedema
Fatigue

28
Q

What are the signs of mitral regurgitation?

A

Displaced apex
Pansystolic murmur – Axilla
Cardiomegaly on a CXR

29
Q

What is the treatment of mitral regurgitation?

A 
Medication
-	Diuretics and heart failure (ACE inhibitors)
Surgical
-	Repair – prolapse
-	Replacement - degenerative
Percutaneous
-	Clips in infancy
30
Q

What is the cause of mitral stenosis?

A

Rheumatic fever

Rare: congenital

31
Q

What are the symptoms of mitral stenosis?

A

Breathlessness
Fatigue
Palpitations (AF)

32
Q

What are the signs of mitral stenosis?

A

Malar flush – co2 retention
Tapping apex beat
Mid diastolic rumbling diastolic murmur localised to apex

33
Q

What is the treatment of mitral stenosis?

A 
Medication
-	Diuretics and treat AF
Surgery
-	Valve replacement
-	Balloon Valvuloplasty
34
Q

What are the causes of aortic regurgitation?

A 
Leaflets
-	Endocarditis
-	Connective tissue diseases
-	Rheumatic
Annulus
-	Marfans
-	Aortic dissection
35
Q

What is the symptom of aortic regurgitation?

A

Breathlessness

36
Q

What are the signs of aortic regurgitation?

A

Collapsing pulse
Wide pulse pressure
Displaced apex
Early diastolic murmur left sternal edge

37
Q

What is the treatment of aortic regurgitation?

A 
Medication
-	ACE inhibitors
Surgery
-	Symptoms and LV dilatation
-	Valve replacement

1. Cardiovascular (30 decks)

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