Murmurs Flashcards
What are the four valves of the heart?
- Mitral valve
- Aortic valve
- Tricuspid valve
- Pulmonary valve
These valves regulate blood flow through the heart during different phases of the cardiac cycle.
During diastole, what is the state of the left ventricle and the mitral valve?
Left ventricle relaxed = Mitral valve OPEN
This allows blood to flow from the left atrium into the left ventricle.
During systole, what happens to the aortic valve?
Aortic valve OPEN
This occurs as the left ventricle contracts to pump blood into the aorta.
What does S1 represent in heart sounds?
Closing of atrioventricular valves = tricuspid + mitral valve
S1 is often referred to as the ‘LUB’ sound.
What does S2 represent in heart sounds?
Closing of semi-lunar valves = pulmonary and aortic valve
S2 is often referred to as the ‘DUB’ sound.
What is a murmur?
Turbulent blood flow
Murmurs can indicate various cardiac conditions.
What is stenosis in relation to heart valves?
Valve opening becomes narrow and restricts blood flow
This can lead to increased pressure in the heart.
What is regurgitation in heart valves?
When blood leaks backward through a valve, sometimes due to prolapse
This can cause volume overload in the heart.
Which breath do right-sided murmurs become louder on?
Inspiration
(RILE)
This includes pulmonary and tricuspid murmurs.
Which breath do left-sided murmurs become louder on?
Expiration
(RILE)
This includes aortic and mitral murmurs.
What is the significance of the left lateral position during cardiac examination?
Accentuates mitral murmurs
This position helps in better auscultation of the mitral valve.
What type of murmur is associated with aortic stenosis?
Ejection systolic
This is the most common type of systolic murmur.
What are the signs of aortic stenosis?
- SAD (Syncope, Angina, Dyspnoea)
- Slow rising pulse
- Narrow pulse pressure
- Soft S2 heart sound
- Present S4
These signs help in clinical diagnosis of aortic stenosis.
What type of murmur is mitral regurgitation?
Pansystolic
It is the second most common systolic murmur.
What are common causes of mitral regurgitation?
- Infective endocarditis
- Post MI: Papillary muscle or Chordae tendinae rupture
- Mitral valve prolapse
- Rheumatic heart disease
- Ehlers-Danlos syndrome/Marfans
These conditions can lead to functional impairment of the mitral valve.
What is the characteristic of ejection systolic murmurs?
Crescendo-Decrescendo
This is typical of aortic stenosis and pulmonary stenosis.
What is the best position to hear aortic murmurs?
On expiration when leaning forward
This enhances the audibility of the aortic valve sounds.
What is a common finding on an ECG for patients with ASD?
RBBB (Right Bundle Branch Block)
This is indicative of right heart volume overload.
What is aortic sclerosis?
Thickening of the valve leaflets without narrowing of the orifice
This is often seen in the elderly and is generally asymptomatic.
What is the murmur associated with tricuspid regurgitation?
Pansystolic murmur
It is loudest on inspiration.
Which congenital heart defect is most likely to be found in adulthood?
Atrial Septal Defect (ASD)
It can remain asymptomatic for many years.
What are the two types of ASD?
- Ostium secundum
- Ostium primum
Ostium secundum is more common.
What type of murmur is associated with aortic regurgitation?
Early diastolic
It is characterized by a decrescendo sound.
What are the signs of mitral stenosis?
- Dyspnoea
- Haemoptysis
- Loud S1
- Opening snap
- Malar flush
- Atrial fibrillation
These symptoms can indicate significant obstruction to left ventricular filling.
What is the characteristic sound of pulmonary regurgitation?
Early diastolic
This is often referred to as Graham Steel murmur.
What type of murmur is associated with patent ductus arteriosus (PDA)?
Continuous machine-like murmur
This is due to the continuous flow of blood from the aorta to the pulmonary artery.
What are the heart sounds and their corresponding events?
S1: AV closed (mitral/tricuspid) + pulse palpable!!!
S2: Semi-lunar valves closed (aortic/pulmonary)
AV valves include tricuspid and mitral; semi-lunar valves include aortic and pulmonary.
What is the mnemonic for systolic and diastolic murmurs?
ASMR - SYSTOLIC
ARMS - DIASTOLIC
Helps remember the types of murmurs based on timing.
What causes a physiological (innocent) murmur?
- Turbulent blood flow through a NORMAL valve
- Most common = Still’s
- Most often a systolic murmur, soft blowing sound
Innocent murmurs are common and usually not a cause for concern.
What are the two types of non-pathological murmurs?
Functional and innocent
Structural cardiovascular disease is absent in these types.
What is the difference between pathological and non-pathological murmurs?
Pathological: Structural cardiovascular lesion absent;
Non-pathological: Structural cardiovascular lesion present
Helps in identifying the seriousness of the murmur.
What characterizes a systolic murmur?
Produced during systole (contraction) between S1 - S2
Systolic murmurs occur when the heart is contracting.
What characterizes a diastolic murmur?
Produced during diastole (relaxation) between S2 - S1
Diastolic murmurs occur when the heart is relaxed.
Types of Systolic murmur
- Ejection systolic
- Pansystolic/holosystolic
- late systolic
Soft systolic
Types of diastolic murmur
- Early diastolic murmur
- Mid-late diastolic murmur
Causes include infective endocarditis and rheumatic fever.
Causes of ejection systolic murmur (2)
- Aortic Stenosis
- Pulmonary stenosis
- ASD
Causes of pansystolic murmurs
- Mitral regurg
- Tricuspid regurg
- VSD
What is an innocent murmur?
Sounds like a soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
Typically heard in systole.
What is the Levine scale used for?
Grade of Murmur - 1-6 (intensity)
1 = very faint
6 = very loud, heard with no steth
Helps classify the intensity of murmurs.
