murmurs Flashcards
s1 is caused by
closing of atrioventricular valves (tricuspid and mitral) at start of systole
S2 is caused by
closing of semilunar valves (pulmonary and aortic valves at end of systole
S3 in young people
can be normal - heart functions so well that ventricles easily allow rapid filling
S3 in older people
heart failure
when is s3 heard
~0.1s after s2
when is S4 heard
directly before s1
s4
always abnormal
–> stiff/hypertrophic ventricle
assessing a murmur - SCRIPT
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
what does murmur pitch indicate
velocity
hypertrophy vs dilatation
valvular heart disease can cause hypertrophy or dilatation (thinning + expanding) of myocardium in different areas
hypertrophy vs dilatation what does mitral stenosis cause
left atrial hypertrophy
hypertrophy vs dilatation what does aortic stenosis cause
left ventricular hypertrophy
hypertrophy vs dilatation what does mitral regurgitation cause
left atrial dilatation
hypertrophy vs dilatation what does aortic regurgitation cause
left ventricular dilatation
mitral stenosis
narrow mitral valve making it difficult for the L atrium to push blood through to the ventricle
causes of mitral stenosis
rheumatic heart disease
infective endocarditis
mitral stenosis murmur
mid-diastolic, low pitched ‘rumbling’ murmur
loud s1
what is mitral stenosis assoc with
malar flush - back pressure into pulmonary system causing rise in CO2 and vasodilation
AF
mitral regurgitation
incompetent mitral valve allows blood to leak back through during systole
mitral regurgitation leads to….
congestive cardiac failure –> leaking valve caused reduced ejection fraction and backlog of blood
mitral regurgitation murmur
pan-systolic high pitched ‘whistling’ murmur
radiates to left axilla
mitral regurgitation causes
idiopathic valve weakening IHD infective endocarditis rheumatic heart disease connective tissue disorders e.g. Marfan
aortic stenosis murmur
ejection-systolic, high-pitched murmur
crescendo-decrescendo
radiates to carotids
aortic stenosis sights
carotid radiation
slow rising pulse
narrow pulse pressure
exertional sycope
aortic stenosis causes
idiopathic age-related calcification
rheumatic heart diseas
aortic regurgitation murmur
early diastolic, soft murmur
collapsing pulse too
what is collapsing pulse
rapidlly appearing and dissapearing pulse at carotid as blood is pumped out ventricle and then immediately flows back
aortic regurgitation results in…
heart failure –> blood backlog
aortic regurgitation causes
idiopathic age-related weakness
connective tissue disorder e.g. marfan’s
aortic stenosis Mx
asymptomatic - observe
symptomatic - valve replacement
asymptomatic but valvular gradient >40mmHg - consider surgery