murmurs Flashcards
what takes place after the first heart sound?
systole
what takes place after the second heart sound?
diastole
what investigation diagnosis murmurs?
ECHO
what causes aortic stenosis?
congenital bicuspid valve (2 leaflets instead of 3) (seen in <65)
rheumatic heart disease
age related calcification and degeneration >65
what symptoms would be seen in aortic stenosis?
SOB
chest pain
dizziness and blackouts
what sign is seen with aortic stenosis?
ejection systolic murmur heard in the aortic region and radiates to the carotids
what additional signs are seen with aortic stenosis?
slow rising pulse narrow pulse pressure splitting of second heart sound crescendo and decrescendo in nature S4 (indicative of LVH) soft/absent S2
what complications can aortic stenosis cause?
angina
syncope
heart failure
what is the management for aortic stenosis?
surgery - valve replacement
TAVI - trans aortic valve implantation
(surgery needed as poor prognosis due to progressive heart failure)
what causes mitral regurgitation?
left ventricular dilation
degenerative rupture of cadre tendinae
endocarditis
what symptoms are seen with mitral regurgitation?
SOB
fatigue
peripheral oedema
what sign is seen with mitral regurgitation?
pan systolic murmur best heard at the apex beat and radiates to the axilla
what additional signs are seen with mitral regurgitation?
displaced apex
splitting of second heart sound
what is the management of mitral regurgitation?
heart failure control - ACEi, BB, spironolactone
surgery intervention in severe - repair rather than replace
what causes aortic regurgitation?
acute - endocarditis, aortic dissection
Marfans
what symptoms are seen with aortic regurgitation?
SOB, orthopnea
chest pain
dizziness
what sign is seen with aortic regurgitation?
early diastolic murmur best heard when patient is sitting forward and expiring
what additional signs are seen with aortic regurgitation?
displaced apex
collapsing pulse
De Muessets sign - head nodding with each beat
Quincke’s sign - pulsation in capillary nail beds
wide pulse pressure
what are complications of aortic regurgitation?
heart failure
LV hypertrophy
what is the management of aortic regurgitation?
control hypertension - ACEi
surgery valve replacement - when LVH/HF progresses
what causes mitral stenosis?
rheumatic heart disease
what symptoms are seen with mitral stenosis?
SOB
fatigue
palpitations - AF
what sign is seen with mitral stenosis?
rumbling mid-late diastolic murmur best heard with patient lying on side and expiring
what additional signs are seen with mitral stenosis?
malar rash
opening snap on S1
AF
what it the management for mitral stenosis?
SOB - ACEi/diuretic
AF - rate control and anti-coagulation
surgical - valloon valvuloplasty/valve replacement
what is the sign of patent ductus arteriosus?
constant machine like murmur
