Murmurs Flashcards
Which of the following is a clinical marker of severe aortic stenosis (AS)?
1- ejection systolic murmur, loudest over the aortic area
2- soft second heart sound (s2)
Wide pulse pressure is a sign of
aortic regurgitation (AR).
What are the clinical presentations of aortic stenosis?
Syncope, Shortness of Breath and Angina
What type of murmur and where will aortic stenosis be heard?
Ejection Systolic Murmur, heard best over right Upper Right Sternal Edge
What type of murmur and where will mitral regurgitation be heard?
Pansystolic Murmur, best heard over the Apex
HARD ASS MRS MSD
Abbreviate meaning-
Aortic Regurgitation- Diastolic
Aortic Stenosis- Systolic
Mitral Regurgitation- Systolic
Mitral Stenosis- Diastolic
What does the open snap indicate in mitral stenosis?
Indicates the leaflets still have some mobility. (remember it is bicuspid)
Features of mitral stenosis
dyspnoea
haemotypsis
mid late diastolic murmur
MALAR FLUSH
loud S1
opening snap
armsprts
diastolic
psasmrtr
systolic
early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre
collapsing pulse
wide pulse pressure
Quincke’s sign (nailbed pulsation)
De Musset’s sign (head bobbing)
mid-diastolic Austin-Flint murmur in severe ….- due to partial closure of the anterior mitral valve cusps caused by the ……..streams
These features, what do they indicate?
Aortic Regurgitation
Which of the following is a clinical marker of aortic regurgitation (AR)?
- Quincke’s sign (nailbed pulsation) is a clinical sign of aortic regurgitation
- Early/ Mid-late diastolic Murmur
Suspected AR should be investigated with ……..
echocardiography
Management of AR
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
Chronic Presentation of;
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)
This features what do they indication, what could be a possible cause?
AR, due to valvular disease
Acute Presentation of ;
- infective endocarditis
This feature what do they indication, what could be a possible cause?
AR, due to valvular disease
Chronic Presentation of;
bicuspid aortic valve (affects both the valves and the aortic root)
spondylarthropathies (e.g. ankylosing spondylitis)
hypertension
syphilis
Marfan’s, Ehler-Danlos syndrome
This features what do they indication, what could be a possible cause?
AR, due to aortic root disease
Acute Presentation of ;
- aortic dissection
This feature what do they indication, what could be a possible cause?
AR, due to aortic root disease
RheuMATic fever affects: Mitral valve > Aortic valve»_space; Triscuspid valve, in order of frequency (from USMLE FirstAid 2020)
RheuMATic fever affects: Mitral valve > Aortic valve»_space; Triscuspid valve, in order of frequency (from USMLE FirstAid 2020)
A late systolic murmur is typically associated with ….
coarctation of the aorta and mitral valve prolapse.
A pan-systolic murmur may be present in…..
mitral or tricuspid regurgitation, and ventricular septal defects.
A continuous, machine-like murmur is the typical murmur associated with….
patent ductus arteriosus (PDA). This most commonly presents in infancy.
An ejection systolic murmur is most commonly associated with
- aortic stenosis (AS) or hypertrophic obstructive cardiomyopathy (HOCM) if louder on expiration
- pulmonary stenosis
- atrial septal defect if louder on inspiration
- It may also be present in tetralogy of Fallot.
In mild AR, the murmur is typically ……..diastolic, and in severe AR, the murmur may be ………… diastolic.
In mild AR, the murmur is typically early diastolic, and in severe AR, the murmur may be mid-late diastolic.
Narrow Pulse Pressure seen in,
Aortic Stenosis
Collapsing Pulse seen in,
Aortic Regurgitation
Corrigan’s sign refers to the rapid upstroke and collapse of the carotid artery pulse, also seen in .
aortic regurgitation
Differentiate both Tricuspid regurgitation and mitral regurgitation, both have pan systolic murmur.
Tricuspid regurgitation becomes louder during inspiration, unlike mitral regurgitation
Mnemonic of RILE, interpret it
RILE
Right-sided murmur → heard best on Inspiration
Left-sided murmur → heard best on Expiration
Ejection systolic in loud in inspiration
-louder on inspiration
pulmonary stenosis
atrial septal defect
also: tetralogy of Fallot
Late systolic
mitral valve prolapse
coarctation of aorta
Early diastolic
aortic regurgitation (high-pitched and ‘blowing’ in character)
Mid-late diastolic
mitral stenosis (‘rumbling’ in character)
Continuous machine-like murmur
patent ductus arteriosus
Holosystolic (pansystolic)
- mitral/tricuspid regurgitation (high-pitched and ‘blowing’ in character)
(tricuspid regurgitation becomes louder during inspiration, unlike mitral reguritation)
- ventricular septal defect (‘harsh’ in character)
Ejection systolic in loud in expiration
-louder on expiration
aortic stenosis
hypertrophic obstructive cardiomyopathy
chest reveals a systolic murmur heard loudest at the left sternal edge and bilateral femoral pulses are weak.
coarctation of aorta
Aortic stenosis - What is the most common cause in
younger patients < 65 years:
bicuspid aortic valve
Aortic stenosis - What is the most common cause in
older patients > 65 years:
calcification
