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My final year > Murmurs > Flashcards

Murmurs Flashcards

1
Q

Aortic stenosis murmur: sounds

A
  • ejection systolic
  • radiates to carotids
  • louder on expiration
  • soft/absent S2
  • S4
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2
Q

Aortic stenosis: signs

A
  • chest pain
  • dyspnoea
  • syncope/dizziness
  • narrow pulse pressure
  • slow rising pulse
  • thrill
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3
Q

Aortic stenosis: causes

A
  • degenerative calcification (>65)
  • biscupsid aortic valve (<65)
  • post rheumatic disease
  • HOCM (subvalvular)
  • William’s syndrome
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4
Q

Aortic stenosis: management

A
  • Asymptomatic & valvular gradient <40 = observe
  • symptomatic/asymptomatic & valvular gradient >40 = surgery
  • AVR/balloon valvuloplasty
  • Balloon valvuloplasty = for children w no calcification or adults who are not fit for AVR

Surgical AVR = for young/low risk pt
Transcatheter AVR = high risk pt

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5
Q

Aortic regurgitation: murmur

A
  • Early diastolic
  • Mid-late diastolic = Austin-Flint mumur in severe AVR
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6
Q

Aortic regurgitation: signs

A
  • Collapsing pulse
  • Wide pulse pressure
  • Quincke’s sign (nailbed)
  • De musset’s (head bobbing)
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7
Q

Aortic regurg: management

A
  • medical management of any associated heart failure
  • surgery: aortic valve indications include:
    symptomatic patients with severe AR
    asymptomatic patients with severe AR who have LV systolic dysfunction
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8
Q

Aortic regurg: causes

A

Causes of AR due to valve disease
* rheumatic fever: the most common cause in the developing world
* calcific valve disease
* connective tissue diseases e.g. rheumatoid arthritis/SLE
* bicuspid aortic valve (affects both the valves and the aortic root)
* infective endocarditis

Causes of AR due to aortic root disease:
* bicuspid aortic valve (affects both the valves and the aortic root)
* spondylarthropathies (e.g. ankylosing spondylitis)
* hypertension
* syphilis
* Marfan’s, Ehler-Danlos syndrome
* Aortic dissection

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9
Q

Mitral stenosis: murmur

A
  • mid-late diastolic murmur (best heard in expiration)
  • loud S1
  • opening snap: indicates mitral valve leaflets are still mobile
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10
Q

mitral stenosis: signs

A
  • dyspnoea
  • haemoptysis: may range from pink frothy sputum to sudden haemorrhage secondary to rupture of thin-walled and dilated bronchial veins
  • low volume pulse
  • malar flush
  • atrial fibrillation
  • Atrial enlargement on CXR
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11
Q

mitral stenosis: managment

A
  • patients with associated atrial fibrillation require anticoagulation: currently warfarin is still recommended for patients with moderate/severe MS
  • asymptomatic patients: monitored with regular echocardiograms
  • symptomatic patients: percutaneous mitral balloon valvotomy, mitral valve surgery (commissurotomy, or valve replacement)
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12
Q

Mitral regurgitation: sounds

A
  • pansystolic murmur described as “blowing”
  • heard best at the apex and radiating into the axilla
  • S1 may be quiet as a result of incomplete closure of the valve
  • severe MR may cause a widely split S2
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13
Q

mitral stenosis: causes

A
  • rheumatic fever
    Rarer causes that may be seen in the exam include mucopolysaccharidoses, carcinoid and endocardial fibroelastosis
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14
Q

mitral regurg: causes

A
  • Following coronary artery disease or post-MI
  • Mitral valve prolapse
  • Infective endocarditis
  • Rheumatic fever
  • Congenital
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15
Q

mitral regurg: signs

A
  • fatigue
  • shortness of breath
  • oedema
  • Asymptomatic mostly
  • Cardiomegaly
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16
Q

Mitral regug: management

A
  • Medical management in acute cases involves nitrates, diuretics, positive inotropes and an intra-aortic balloon pump to increase cardiac output
  • If patients are in heart failure, ACE inhibitors may be considered along with beta-blockers and spironolactone
  • In acute, severe regurgitation, surgery is indicated
  • The evidence for repair over replacement is strong in degenerative regurgitation, and is demonstrated through lower mortality and higher survival rates
  • When this is not possible, valve replacement with either an artificial valve or a pig valve is considered
17
Q

mitral prolapse: sound

A

late systolic murmur

18
Q

Pulmonary stenosis: sound

A

ejection systolic murmur, louder on inspiration
widely split S2

19
Q

Pulmonary regurgitation: sounds

A
  • early diastolic murmur
  • graham-steel murmur
  • high-pitched & blowing
20
Q

HOCM: sounds

A

ejection systolic murmur (functional aortic stenosis)
louder on expiration
increases with valsalva
decreases on squatting
mitral regurg: pansystolic murmur

21
Q

HOCM: features

A
  • often asymptomatic
  • exertional dyspnoea
  • angina
  • syncope: typically following exercise
  • sudden death (most commonly due to ventricular arrhythmias), arrhythmias, heart failure
  • jerky pulse, large ‘a’ waves, double apex beat
22
Q

HOCM: echo findings

A

mnemonic - MR SAM ASH
mitral regurgitation (MR)
systolic anterior motion (SAM) of the anterior mitral valve leaflet
asymmetric hypertrophy (ASH)

23
Q

HOCM: managment

A

ABCDE
* amiodarone
* beta blockers
* cardioverter defib
* dual chamber pacemaker
* endocarditis prophylaxis
* Myomectomy: to remove obstruction

AVOID: nitrates, ACEi, inotropes

24
Q

VSD: murmur

A

pan-systolic murmur which is louder in smaller defects

25
Q

VSD: causes

A
  • congenital VSDs are often association with chromosomal disorders: Down’s syndrome, Edward’s syndrome. Patau syndrome, cri-du-chat syndrome
  • congenital infections
  • acquired causes: post-myocardial infarction
26
Q

tricuspid regurgitation: signs

A
  • pan-systolic murmur
  • prominent/giant V waves in JVP
  • pulsatile hepatomegaly
  • left parasternal heave
27
Q

tricuspid regurg: causes

A
  • right ventricular infarction
  • pulmonary hypertension e.g. COPD
  • rheumatic heart disease
  • infective endocarditis (especially intravenous drug users)
  • Ebstein’s anomaly
  • carcinoid syndrome
28
Q

ASD: features

A
  • ejection systolic murmur, fixed splitting of S2
  • louder on inspiration
  • embolism may pass from venous system to left side of heart causing a stroke
  • Most commonly ostium secundum
29
Q

Aortic SCLEROSIS

A
  • ejection systolic
  • more common with age than stenosis
  • no radiotion or ECG changes

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