Murmurs Flashcards
Describe the grading system for murmurs
Grade 1: The murmur is heard only on listening intently for some time.
Grade 2: A faint murmur that is heard immediately on auscultation.
Grade 3: A loud murmur with no palpable thrill.
Grade 4: A loud murmur with a palpable thrill.
What type of murmur would aortic stenosis create? (4)
Ejection systolic
Loudest over the aortic valve
Radiates to carotids
‘Crescendo-decrescendo’
What can cause aortic stenosis? (3)
Aortic valve calcification
Congenital abnormality
Rheumatic heart disease
What clinical features can be associated with an aortic stenosis murmur? (4)
Slow rising pulse wit narrow pulse pressure
Non displaced, heaving apex beat (left ventricular hypertrophy)
Reduced or absent S2 (moderate-severe AS)
Reverse splitting of S2 (heart failure - increased time for blood to leave the left ventricle)
What type of murmur would mitral regurgitation create? (4)
Pan systolic
Loudest over mitral area
Radiates to axilla
Loudest in expiration when patient lead on left side
What can cause mitral regurgitation?
Infective endocarditis
MI - rupture of papillary muscle
Rheumatic heart disease
Congenital defect
Cardiomyopathy
What clinical feature can be associated with mitral regurgitation?
Displaced hyperdynamic apex beat
What type of murmur can aortic regurgitation create? (4)
Early diastolic
Decrescendo
Loudest at left sternal age
Austin Flint Murmur (severe)
What is an Austin Flint murmur?
Low pitched rumbling mid-diastolic
Loudest at apex
Regurgitated blood mixes with left atrium in severe aortic regurgitation
What clinical features can be associated with an aortic regurgitation? (7)
Collapsing pulse (water hammer)
Displaced hyperdynamic apex beat
Corrigan’s sign (distention and collapse of carotids)
De Musset’s sign (head bobbing pulsations)
Quincke’s sign (nail bed pulsations)
Traube’s sign (pistole shot over femoral artery)
Muller’s sign (uvula pulsations)
What type of murmur can mitral stenosis cause? (5)
Mid diastolic murmur
Loudest over apex
Low pitched rumbling
Opening click
Heard best when patient lying on left side
What clinical features can be associated with mitral stenosis? (3)
Low volume irregularly irregular pulse (AF)
Loud S1 with tapping apex beat (palpable closing of the mitral valve)
Malar flush
What is Malar flush?
Plum-red discolouration of the cheeks
What can cause mitral stenosis?
Rheumatic fever (most common)
Congenital
Left atrial myxoma
Connective tissue disorders
Mucopolysaccharidosis
What is an atrial myxoma?
Benign tumour
