murmurs

Question 1

s1 is caused by

Answer 1

closing of atrioventricular valves (tricuspid and mitral) at start of systole

Question 2

S2 is caused by

Answer 2

closing of semilunar valves (pulmonary and aortic valves at end of systole

Question 3

S3 in young people

Answer 3

can be normal - heart functions so well that ventricles easily allow rapid filling

Question 4

S3 in older people

Answer 4

heart failure

Question 5

when is s3 heard

Answer 5

~0.1s after s2

Question 6

when is S4 heard

Answer 6

directly before s1

Question 7

s4

Answer 7

always abnormal

–> stiff/hypertrophic ventricle

Question 8

assessing a murmur - SCRIPT

Answer 8

s: site - where is murmur loudest
c: character - soft, blowing, crescendo etc
r: radiation
i: intensity - grade
p: pitch - high or low
t: timing - systolic or diastolic

Question 9

what does murmur pitch indicate

Answer 9

velocity

Question 10

hypertrophy vs dilatation

Answer 10

valvular heart disease can cause hypertrophy or dilatation (thinning + expanding) of myocardium in different areas

Question 11

hypertrophy vs dilatation what does mitral stenosis cause

Answer 11

left atrial hypertrophy

Question 12

hypertrophy vs dilatation what does aortic stenosis cause

Answer 12

left ventricular hypertrophy

Question 13

hypertrophy vs dilatation what does mitral regurgitation cause

Answer 13

left atrial dilatation

Question 14

hypertrophy vs dilatation what does aortic regurgitation cause

Answer 14

left ventricular dilatation

Question 15

mitral stenosis

Answer 15

narrow mitral valve making it difficult for the L atrium to push blood through to the ventricle

Question 16

causes of mitral stenosis

Answer 16

rheumatic heart disease

infective endocarditis

Question 17

mitral stenosis murmur

Answer 17

mid-diastolic, low pitched ‘rumbling’ murmur

loud s1

Question 18

what is mitral stenosis assoc with

Answer 18

malar flush - back pressure into pulmonary system causing rise in CO2 and vasodilation

AF

Question 19

mitral regurgitation

Answer 19

incompetent mitral valve allows blood to leak back through during systole

Question 20

mitral regurgitation leads to….

Answer 20

congestive cardiac failure –> leaking valve caused reduced ejection fraction and backlog of blood

Question 21

mitral regurgitation murmur

Answer 21

pan-systolic high pitched ‘whistling’ murmur

radiates to left axilla

Question 22

mitral regurgitation causes

Answer 22

idiopathic valve weakening 
IHD
infective endocarditis
rheumatic heart disease
connective tissue disorders e.g. Marfan

Question 23

aortic stenosis murmur

Answer 23

ejection-systolic, high-pitched murmur
crescendo-decrescendo
radiates to carotids

Question 24

aortic stenosis sights

Answer 24

carotid radiation
slow rising pulse
narrow pulse pressure
exertional sycope

Question 25

aortic stenosis causes

Answer 25

idiopathic age-related calcification

rheumatic heart diseas

Question 26

aortic regurgitation murmur

Answer 26

early diastolic, soft murmur

collapsing pulse too

Question 27

what is collapsing pulse

Answer 27

rapidlly appearing and dissapearing pulse at carotid as blood is pumped out ventricle and then immediately flows back

Question 28

aortic regurgitation results in…

Answer 28

heart failure –> blood backlog

Question 29

aortic regurgitation causes

Answer 29

idiopathic age-related weakness

connective tissue disorder e.g. marfan’s

Question 30

aortic stenosis Mx

Answer 30

asymptomatic - observe
symptomatic - valve replacement
asymptomatic but valvular gradient >40mmHg - consider surgery