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Medicine > Murmur/valvular disorders > Flashcards

Murmur/valvular disorders Flashcards

1
Q

aortic stenosis murmur

A

ejection systolic murmur
high pitched
crescendo decrescendo
Radiates to carotid

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2
Q

Where is aortic stenosis best heard

A

Best heard in arotic area,right parasternal 2nd intercostal space.
Laouder on expiration

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3
Q

Causes of aortic stenosis

A

congenital aortic stenosis ( rare, infancy)
Premature calcification of bicuspid valve ( common, 30-40y)
Calcification of a normal/tricuspid valve ( most common, 65y)

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4
Q

aortic stenosis features

A

slow rising pulse
narrow pulse pressure
1. dizziness.syncope
2. effort dyspnoea
3. effort angina/palpitations

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5
Q

Aortic stenosis management

A

ECHO to monitor/assess severity
Surgery
- conventional
- TAVI (used in surgery high risk/elderly)

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6
Q

mitral regurgitation murmur

A

loud pan systolic murmur at apex
high pitched whistle
radiates to axilla
loudness associated with severity
louder on expiration

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7
Q

Additional mitral regurgitation features

A

Asymptomatic for many years, presentation picture of HF, displaced and diffuse apex beat resulting from vol overload,

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8
Q

Causes of mitral regurgitation

A
  1. Intrinsic valve problems eg rheumatic heart disease, IE,chordal rupture/prolapse, papillary muscle rupture ,IHD, connective tissue disorders
  2. Secondary/functional (LV dysfunction results in its dilation)
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9
Q

Mitral regurgitation management

A

Medical HF therapy (diuretic, ACEi)
Surgery for mitral valve repair or replacement

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10
Q

Aortic regurgitation murmur

A

early soft diastolic decrescendo murmur
loudness is marker of severity

best heard if patient sits forward at left sternal edge

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11
Q

How to hear aortic regurgitation best

A

heard best left sternal edge, 3/4th IC space
Patient leans forward, breathes in , holds, breaths out and will hear it in end expiration

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12
Q

aortic regurgitation features

A

~~~
collapsing/water hopper pulse
wide pulse pressure
quinces sign
head bobbing (de mussels)
Austin flint murmur
corrigans
duroziez murmur
pistol shot femorals
markers of severity

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13
Q

Causes of aortic regurgitation

A
  1. Diseases affecting aortic valve eg rheumatic heart disease, iE, SLE
  2. Diseases resulting in dilation of aortic root eg aortic aneurysm, Marfan,ankylosign spondylitis,syphilis
  3. Acute cause could be aortic dissection
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14
Q

Aortic regurgitation Mx

A

Medical therapy ( HF)
Surgery (conventional aortic valve replacement)

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15
Q

mitral stenosis murmur

A

low pitched rumbling mid diastolic murmur
best heard if patient is on left side and listen at apex

best heard at apex if patient lays on left hand side

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16
Q

mitral stenosis features

A

AF
RV heave due to p. HTN
malar flush
graham steel murmur (pulmonary regurgitation, again high-pitched and ‘blowing’ in character)

17
Q

Causes of mitral stenosis

A

Mainly rheumatic disease

18
Q

Mitral stenosis management

A

Medical therapy (diuretics, and rate control/anitcoag if AF)
Surgery
- mitral vagotomy
- mitral valve replacement

19
Q

S4

A

abnormal
stiff/hypertrophic ventricle
HF, ischameia, cardiomyopathy, post MI fibrosis
heard in late diastole

TEN-NE-SSEE
S4-S1-S2

https://www.youtube.com/watch?v=KcMF8rJDTIk

20
Q

Which are systolic and diastolic murmurs

A

MR AS-S

AR MS-D

21
Q

S3

A

Can be normal in young/athlete/pregnancy
Abnormal in elderly (cardiomyopathy, HF, mitral or tricuspid regurgitation)
KEN-TUCK-KY
S1-S2-S3

https://www.youtube.com/watch?v=_i2D1KZkN1w

22
Q

Atrial septal defects

A

ejection systolic murmur louder on inspiration
fixed split S2
many are asymptomatic in childhood if untreated then produce symptoms when adult

23
Q

Mitral valve prolapse murmur

A

midsystolic
louder on expiration rather than inspiration.

24
Q

Still’s/innocent murmur

A

common quiet systolic murmur heard in young children
do not progress to give symptoms
generally cannot be heard into adulthood.

25
Q

hypertrophic obstructive cardiomyopathy

A

Ejection systolic
louder on expiration

26
Q

Aortic stenosis differential

A

aortic sclerosis
no radiation of the murmur to the carotids and the ECG is normal

27
Q

Pulmonary stenosis

A

ejection systolic murmur, heard loudest in inspiration. associated with dyspnoea.
in rare cases, it is associated with malignant carcinoid.

28
Q

When is murmur loudest

A

r’i’ght = inspiration
l’e’ft = expiration

RILE:
Right Sided louder on Inspiration
Left Sided louder on Expiration

Blood goes INto the right side of the heart - right sided murmurs louder on INspiration
Blood EXits the left side of the heart - left sided murmurs louder on EXpiration

Right sided murmur meaning right side of the heart and left sided meaning left side of the heart. Not referring to where the murmur is heard on the chest.

29
Q

Continuous machine-like murmur

A

patent ductus arteriosus

30
Q

tricuspid regurgitation

A

pansystolic
louder in inspiration
Loudest in the 4th intercostal left parasternal region.

31
Q

Aortic stenosis differential

A

aortic sclerosis
no radiation of the murmur to the carotids and the ECG is normal

32
Q

Location of tricuspid valve

A

Tricuspid valve is located between the right atrium and the right ventricle.

33
Q

Location of Pulmonary valve

A

Pulmonary valve is located between the right ventricle and the pulmonary artery.

34
Q

Location of Mitral valve

A

Mitral valve is located between the left atrium and the left ventricle. It has only 2 leaflets.

35
Q

Location of aortic valve

A

The aortic valve is located between the left ventricle and the aorta.

36
Q

HOCM associated murmur

A

tends to be ejection systolic, and loudest on expiration.
may cause heart failure and a murmur at the lower left sternal edge.

37
Q

Ventricular septal defect

A

harsh pansystolic murmur at the lower left sternal edge

38
Q

Levine grading scale

A

Grade 1 - Very faint murmur, frequently overlooked
Grade 2 - Slight murmur
Grade 3 - Moderate murmur without palpable thrill
Grade 4 - Loud murmur with palpable thrill
Grade 5 - Very loud murmur with extremely palpable thrill. Can be heard with stethoscope edge
Grade 6 - Extremely loud murmur - can be heard without stethoscope touching the chest wall

39
Q

Heart sound refresher

A

https://www.youtube.com/watch?v=dBwr2GZCmQM

Medicine (72 decks)

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