Murmurs

Question 1

Signs of pul htn

Answer 1

Left parasternal heave (Rv hyper trophy)
Loud +/- palpable pulmonary second heart sound
Graham steel murmur of pulmonary regurgitation (one cause of mitral stenonsis)
Functional tricuspid regu

Question 2

Heart failure types and causes

Answer 2

Systolic hf - abnormality in contractile capacity leading to deficient expulsion of blood
(More common and result in hypotensionh

Diastolic - inability of ventricle to relax and fill normally
(Results in congestion)

Question 3

Causes of hf

Answer 3

Rmb as hearts

Hypertension
Epi(peri) Cardial disease (eg. Constructive pericarditis, pericardial effusion)
Ami, afib
Regurgitate and steno tic valvular disease
Restrictive, hypertrophic and dilated cardiomyopathy
Thyrotoxicosis and anaemia
Shunts like asd and vsd

Question 4

Cause of diastolic hf

Answer 4

Pressure overload with ventricular hyper trophy
- hypotension, aortic stenosis
Cardiomyopathy
- hypertrophic obstructive carisomyopathy
Restrictive cardiomyopathy

Question 5

Mitral stenosis features

Answer 5

Loud s1 +/- open snap
Mid diastolic murmur +/- presystolic accentuaiton (absent in af)
+/- irregular irregular pulse (af), raised jvp (rhf), if afib a wave is absent, loud p2, pedal Odema

Question 6

Features of severe mitral stenosis

Answer 6

Longer mid diastolic murmur
Shorter interval between s2 and open snap
Pulmonary htn
Rhf

Question 7

Complications and causes of mitrals stenosis

Answer 7

Complications
- pulmonary htn, af (stroke?, cardiac failure (right), endocarditis (infective)

Cause
- child rheumatic fever (99%)
Congenital - parachute valve
Calcification degeneration
Connective tissue disease (ra, sle) 
Carcinoid syndrome (bronchial)

Question 8

Investigations and mx of mitral stenosis

Answer 8

ecg - left atrial englargement (biphasic p wave in lead v1), afib
Chest X-ray
- left atrial enlargement (double shadow in right cardiac silhouette, straighten of left cardiac border)
- pulmonary congestion
Mitral valve calcification

Mx
- asym : antibiotic prophylaxis before invasive procedure (amoxycillin 2g one hour before or clindamycin 600mg/ azithromycin 500mg or clarithromycin 500 mg)

Sym: diuretic if mild, severe balloon balloting or surgery (replace or repair)

Question 9

What is pulmonary htn

Answer 9

When systolic and mean pressure in pylon art arteries excess 30 and 20 mmhg