Murmur findings Flashcards
Aortic Stenosis: presentation
aSx until mod/severe stenosis
triad: SOB, chest pain/angina, syncope
worse on exertion
risk of sudden death
degenerative calcification, congenital bicuspid, RhF
Aortic Stenosis: examination
narrow pulse pressure
small volume, slow rising pulse
ejection systolic murmur, loudest in expiration and aortic area
quite/absent S2, may have S4 (tennessee)
radiation to carotids
Mitral Regurg: presentation
often aSx
triad: palpitations, cachexia/hepatomegaly, CCF features
*CCF: fatigue, orthopnoea, dyspnoea
risk of SBE and VTE
RhF/inflamm, MI, IE, DCM, CTD (‘floppy valve)
Mitral Regurg: examination
AF, RHF/pulm HTN Sx2 (oedema, plethora, hepmeg)
lateral apex, thrill
pansystolic murmur, loudest in expiration and mitral area
soft S1, normal S2, may have S3 (kentucky)
radiation to axilla, louder leaning left
Aortic Regurg: presentation
aSx until LVF occurs
syncope, palpitations, chest pain, CCF
*CCF: dyspnoea, orthopnoea, fatigue
RhF/inflamm, IE, calcifcation, CTD
Aortic Regurg: examination
bounding/collapsing pulse, wide PP, lateral apex beat
nail bed pulse (Quincke), head nod (De Musset), flushed, pistol fems, large carotid (Corrigan)
early diastolic murmur, loudest in expiration at Erb’s point
normal S1, may have MDM (Austin Flint) if severe
Mitral Stenosis: presentation
aSx until moderate
SOB, haemoptysis, RHF, AF/palpitations, large LA
large LA: haemoptysis, dysphagia, hoarse (RLN)
risk of emboli
RhF, congenital
Mitral Stenosis: examination
malar flush (mitral facies), small volume pulse, ^JVP heave, apex 'tapping'
rumbling mid diastolic murmur, loudest left lateral with bell
loud S1 (pressure to close), opening snap
may have pre-systolic (Graham Steele)
Pulmonary Stenosis
aSx until more severe
RHF + syncope
RV heave
harsh mid-systolic ejection murmur, louder on inspiration
soft P2, S4 if severe
Tricuspid Regurg
RHF symptoms, arterialised JVP, RV heave
blowing pansystolic murmur, louder on inspiration
Pulmonary Regurg
aSx, no Tx needed
decrescendo diastolic murmur, starts at P2
Tricuspid Stenosis
symptoms similar to LVF abdo pain (hepmeg), ascites, oedema, dyspnoea,
rumbling mid-diastolic murmur
may have opening snap (S1)
CXR changes
AS: dilated arch, small heart, calcified valve
MR: large LV and LA
AR: LVH, dilated arch
MS: pulmonary oedema, small heart, large LA
ECG changes
AS: LVH + strain, ?LAD/LBBB/pulmonary (P)
MR: P mitrale, LVH, ?AF
AR: LVH
MS: P mitrale, RAD, AF
treatments
AS: diuretic +/- statin;
*Sx/severe = replace (TAVI/percut plasty)
MR: warfarin, AF/CCF Tx, diuretics;
*refractory/deterioration = repair/replace (pre-LVF!)
AR: diuretics, ACEI, ?BB/CCb, digoxin;
*Sx/CXR/TWI (ECG) = surgery (pre-LVF!)
MS: warfarin, AF, diuretics
*refractory = surgery (balloon plasy, otomy, replace)
