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1- Cardiology > Murmurs > Flashcards

Murmurs Flashcards

1
Q

Mitral stenosis

A

Diastolic

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2
Q

Aetiology mitral stenosis

A

Rheumatic heart disease

Congenital (rare)

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3
Q

Mitral stenosis clinical features

A

malar flush (butterfly rash)
Dyspnoea
Orthopnoea

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4
Q

Mitral stenosis examination

A 
Diastolic murmur 
- low-pitched and rumbling 
-best heard on expiration 
Small volume pulse
Tapping apex beat

F (severe)

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5
Q

Mitral stenosis investigation

A

Confirm: transthoracic echo

Chest X-ray

  • left atrial enlargement
  • Straightening of left heart border

ECG

  • bifid P wave
  • AF frequently present
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6
Q

management of mitral stenosis

A

Treat AF
- Anticoagulant, BB, Cardioversion, CCB, digoxin

Diuretic

  • Relieve symptoms
  • bendrofluazide

Surgery

  • balloon valvotomy
  • mitraal valve replacement
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7
Q

mitral regurgitation

A

systolic

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8
Q

Aetiology of mitral regurgitation

A

infective endocarditis
Rheumatic heart disease
Degenerative disease
Ischaemic heart disease

Associations

  • Cardiomyopathy: dilated 7 hypertrophic
  • Collagen: Marfans
  • Rheumatic Autoimmune: SLE
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9
Q

Clinical features of mitral regurgitation

A

Dyspnoea on exertion
decreased exercise tolerance
Fatigue

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10
Q

Examination mitral regurgitation

A

Laterally displaced apex
Systolic thrill

Systolic murmur
- blowing, pansystolic

Soft 1st heart sound

Prominent S3

Mid-systolic clock

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11
Q

Mitral regurgitation investigations

A

transthoracic echo

ECG

  • underlying arrhythmia
  • Bifid P wave
  • LV hypertrophy

Chest x-ray
- LA and LV enlargement

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12
Q

management of mitral regurgitation

A

Mild + no symptoms: conservative

Surgical intervention
- symptomatic/ severe
LV dysfunction

Medications

  • Diuretics (bendrofluazide)
  • ACE inhibitor
  • possibly anticoagulant
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13
Q

aortic stenosis

A

systolic

Chronic progressive disease that produces obstruction to the LV stroke volume

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14
Q

Aortic stenosis aetiology

A

Degenerative

  • calcific stenosis of a trileaflet aortic valve
  • calcific aortic valvular disease

Congenital
- stenosis of a bicuspid valve

Rheumatic heart disease

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15
Q

aortic stenosis clinical features

A

Usually no symptoms until severe
Exercise induced syncope
Angina
Dypnoea

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16
Q

Aortic stenosis examination

A

Slow-rising pulse
Low-volume pulse
Systolic thrill in aortic area

Ejection systolic murmur

  • crecendo-decrescendo
  • radiates to carotids
  • heard on expiration

Prominent 4th heart sound (caused by atrial contraction)

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17
Q

Aortic stenosis investigations

A

echo

  • determines severity
  • thickened, calcified & immobile aortic valve cusps

CXR

  • Relatively small heart
  • prominent, dilated ascending aorta

ECG

  • LV hypertrophy & LA delay
  • LV ‘strain’ pattern due to pressure overload

Coronary angiography
-required before surgery is recommended

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18
Q

management of aortic stenosis

A

conventional valve replacement

Trans-catheter aortic valve replacement

Balloon aortic valve replacement

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19
Q

aortic regurgitation

A

diastolic

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20
Q

aortic regurgitation aetiology

A

Acute

  • Rheumatic fever
  • Infective endocarditis
  • Dissection of Aorta
  • ruptured sinus of Valsalve aneurysm
  • Failure of prosthetic valve

Chronic

  • rheumatic heart disease
  • syphilis
  • arthritis
  • severe hypertension
  • bicuspid aortic valve
  • aortic endocarditis
  • marfans
21
Q

Clinical features aortic regurgitation

A

symptoms develop once LV failure occurs

Pounding of the heart
- increased LV size and vigorous pulsation

Dyspnoea
-depends on extent of LV dilatation and dysfunction

22
Q

Aortic regurgitation examination

A

collapsing, large volume pulse
wide pulse pressure

Apex beat displaced laterally and downwards

High pitched early diastolic murmur

  • patieent leaning forwards
  • breath held in expiration
23
Q

Aortic regurgitation investigations

A

echo

  • vigorous cardiac contraction
  • dilated left ventricle

CXR

  • LV enlargement
  • dilatation of ascending aorta

Echo ( LV hypertrophy)

  • Tall R waves
  • Deeply inverted T waves
  • Deep wave

Cardiac catheterisation
- Assess CAD in patients requiring surgery

24
Q

Management of aortic regurgitation

A

LV dysfunction
- ACE inhibitor

BB: Slow aortic dilatation in Marfans

Aortic surgery

25
tricuspid stenosis
Diastolic | Uncommon valve lesion
26
Aetiology: tricuspid stenosis
Rheumatic heart disease associated with mitral/aortic valve disease Seen in carcinoid syndrome More common in women
27
Clinical features of tricuspid stenosis
Symptoms associated left-sided rheumatic valve lesions Abdo pain (hepatomegaly) Peripheral oedema Ascites
28
Tricuspid stenosis examination
Rumbling mid-diastolic murmur | Louder on inspiration
29
Invetigations tricuspid stenos
Echo CXR: Prominent right atrial bulge ECG - enlarged right atrium - peak tall P waves in lead II
30
Tricuspid stenosis management
DIuretic therapy Salt restriction Tricuspid valve replacement
31
tricuspid regurgitation
systolic
32
aetiology tricuspid regurgitation
Function - Cor pulmonale - MI - pulmonary hypertension Organic - Rheumatic heart disease - infective endocarditis - carcinoid syndrome - ebsteins anomaly
33
tricuspid regurgitation clinical features
Symptoms of RHF JVP: v waves Liver: palpable
34
Tricuspid regurgitation examination
Systolic murmur - blowing pan systolic - heard on inspiration
35
Tricuspid regurgitation investigations
Echo | - dilatation of right ventricle with thickening of valve
36
Tricuspid regurgitation management
functional - usually disappears with management Severe organic TR - Operative repair
37
pulmonary stenosis
systolic
38
pulmonary stenosis aetiology
congenital lesion (associated with Fallot's tetralogy) Rheumatic fever Carcinoid syndrome
39
Pulmonary stenosis clinical features
fatigue syncope symptoms of RHF
40
pulmonary stenosis examination
harsh mid-systolic ejection murmur heard in inspiration -associated with a thrill
41
pulmonary stenosis investigations
Doppler echo CXR: prominent pulmonary artery ECG: RA & RV hypertrophy
42
pulmonary stenosis management
Pulmonary valvotomy
43
pulmonary regurgitation
diastolic
44
pulmonary regurgitation aetiology
congenital acquired - tetralogy of fallout repair - left-sided cardiac condition
45
pulmonary regurgitation clinical features
usually asymptomatic - dyspnoea - decreased exercise tolerance
46
pulmonary regurgitation examination
diastolic murmur - decrescendo - heard on inspiration
47
pulmonary regurgitation investigations
transthoracic echo ECG: variable non-specific abnormalities CXR
48
pulmonary regurgitation management
rarely necessary treat underlying cause pulmonary valve replacement if remains symptomatic

1- Cardiology (2 decks)

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