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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
Q

tricuspid stenosis

A

Diastolic

Uncommon valve lesion

26
Q

Aetiology: tricuspid stenosis

A

Rheumatic heart disease
associated with mitral/aortic valve disease

Seen in carcinoid syndrome

More common in women

27
Q

Clinical features of tricuspid stenosis

A

Symptoms associated left-sided rheumatic valve lesions

Abdo pain (hepatomegaly)
Peripheral oedema
Ascites

28
Q

Tricuspid stenosis examination

A

Rumbling mid-diastolic murmur

Louder on inspiration

29
Q

Invetigations tricuspid stenos

A

Echo

CXR: Prominent right atrial bulge

ECG

  • enlarged right atrium
  • peak tall P waves in lead II
30
Q

Tricuspid stenosis management

A

DIuretic therapy
Salt restriction

Tricuspid valve replacement

31
Q

tricuspid regurgitation

A

systolic

32
Q

aetiology tricuspid regurgitation

A

Function

  • Cor pulmonale
  • MI
  • pulmonary hypertension

Organic

  • Rheumatic heart disease
  • infective endocarditis
  • carcinoid syndrome
  • ebsteins anomaly
33
Q

tricuspid regurgitation clinical features

A

Symptoms of RHF

JVP: v waves
Liver: palpable

34
Q

Tricuspid regurgitation examination

A

Systolic murmur

  • blowing pan systolic
  • heard on inspiration
35
Q

Tricuspid regurgitation investigations

A

Echo

- dilatation of right ventricle with thickening of valve

36
Q

Tricuspid regurgitation management

A

functional - usually disappears with management

Severe organic TR
- Operative repair

37
Q

pulmonary stenosis

A

systolic

38
Q

pulmonary stenosis aetiology

A

congenital lesion (associated with Fallot’s tetralogy)

Rheumatic fever
Carcinoid syndrome

39
Q

Pulmonary stenosis clinical features

A

fatigue
syncope
symptoms of RHF

40
Q

pulmonary stenosis examination

A

harsh mid-systolic ejection murmur
heard in inspiration
-associated with a thrill

41
Q

pulmonary stenosis investigations

A

Doppler echo

CXR: prominent pulmonary artery

ECG: RA & RV hypertrophy

42
Q

pulmonary stenosis management

A

Pulmonary valvotomy

43
Q

pulmonary regurgitation

A

diastolic

44
Q

pulmonary regurgitation aetiology

A

congenital

acquired

  • tetralogy of fallout repair
  • left-sided cardiac condition
45
Q

pulmonary regurgitation clinical features

A

usually asymptomatic

  • dyspnoea
  • decreased exercise tolerance
46
Q

pulmonary regurgitation examination

A

diastolic murmur

  • decrescendo
  • heard on inspiration
47
Q

pulmonary regurgitation investigations

A

transthoracic echo

ECG: variable non-specific abnormalities

CXR

48
Q

pulmonary regurgitation management

A

rarely necessary
treat underlying cause
pulmonary valve replacement if remains symptomatic

1- Cardiology (2 decks)

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