Murmurs Flashcards
What does the first heart sound signify
Closure of mitral and tricuspid valves
What does the second heart sound signify
Closure of aortic and pulmonary valves
What is a split S2 sound
Pulmonary valve may close just after the aortic, which is prolonged during inspiration, or in defects which cause more blood to be pumped out the RV
Cause of aortic stenosis
Calcification of aortic valves. Congenital abnormality of aortic valve. Rheumatic heart disease
Cause of mitral regurgitation
Infective endocarditis, acute MI with rupture of papillary muscles, rheumatic heart disease, congenital defects of mitral valve, cardiomyopathy
Valvular causes of aortic regurgitation
Congenital bicuspid aortic valve, rheumatic heart disease, infective endocarditis
Aortic root dilation causes, resulting in aortic regurgitation
Aortic dissection, connective tissue diseases, aortitis
Pulse features of aortic stenosis
slow rising pulse, narrow pulse pressure
S2 in aortic stenosis
Reduced or absent S2, reverse splitting of S2
Apex beat features of mitral regurgitation
Displaced, hyperdynamic
Apex beat features of aortic stenosis
Non-displaced, heaving
Pulse of aortic regurgitation
Collapsing pulse (‘water hammer pulse’ with wide pulse pressure)
Apex beat in aortic regurgitation
Displaced hyperdynamic
Causes of mitral stenosis
Rheumatic disease (most common), congenital, left atrial myxoma, connective tissue disorders and mucopolysachharideosis
Pulse pressures of mitral stenosis
Low volume pulse which may be irregularly regular (AF)
Clinical features of mitral stenosis
Loud first heart sound with tapping apex beat and malar flush
Type of murmur in aortic stenosis
Ejection systolic
When is aortic stenosis murmur heard loudest
Loudest on expiration sitting forward
Where do aortic stenosis murmurs radiate to
Carotid arteries
Type of murmur in mitral regurgitation
Pansystolic murmur
When is mitral regurgitation murmur heard loudest
Loudest using bell, on expiration in left lateral decubitus position
Where do mitral regurgitation murmurs radiate to
Axilla
Type of murmur heard in aortic regurgitation
Decrescendo early diastolic murmur
Murmur heard in severe aortic regurgitation
Austin flint murmur - low pitched rumbling, mid-diastolic murmur head best at apex beat
Where is aortic regurg murmur heard loudest
Left sternal edge and sometimes over aortic area
Type of murmur heard in mitral stenosis
Low pitched rumbling mid-diastolic murmur with opening click
When is mitral stenosis murmur heard loudest
Left lateral decubitus position on expiration
Cause of tricuspid regurgitation
RV dilation, rheumatic fever, infective endocarditis, carcinoid syndrome, congenital causes
Causes of pulmonary stenosis
Turner’s, William’s, Noonan’s syndrome, tetrology of fallot, rheumatic fever, carcinoid syndrome
Causes of pulmonary regurgitation
Pulmonary HTN, infective endocarditis, congenital valvular heart disease
Causes of tricuspid stenosis
Rheumatic fever, congenital disease, infective endocarditis
Type of murmur in tricuspid regurgitation
Pansystolic murmur
Type of murmur in pulmonary stenosis
Ejection systolic murmur
When is tricuspid regurgitation heard loudest
During inspiration
When and where is pulmonary stenosis heard loudest
During inspiration, radiating to left shoulder and infraclavicular region
Type of murmur in pulmonary regurgitation
Early diastolic murmur
When is pulmonary regurgitation murmur heard loudest
During inspiration at left sternal edge
Type of murmur in tricuspid stenosis
Mid-diastolic murmur
When and where is tricuspid stenosis heard loudest
During inspiration at left sternal edge 3rd-4th intercostal region
Clinical features associated with tricuspid regurgitation
Large V waves in jugular veins, visible/palpable hepatic pulsations, signs of right sided heart failure
Clinical features of pulmonary regurgitation
Usually asymptomatic
Clinical features of tricuspid stenosis
Raised JVP with giant A waves and peripheral oedema or ascites
Clinical features of pulmonary stenosis
Prominent A waves in jugular veins, widely split S2, P2 may be soft and inaudible, signs of right sided heart failure
Triad of symptoms associated with aortic stenosis
Heart failure, syncope and angina
Diagnosis and grading of aortic stenosis
Echo
Which valvular heart diseases cause left hypertrophy
Mitral stenosis and aortic stenosis
Which valvular heart diseases cause left dilatation
Mitral and aortic regurgitation
