Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 2 - Cardioresp > Murmurs > Flashcards

Murmurs Flashcards

1
Q

What are the clinical signs in aortic stenosis?

A

Syncope
Chest pain
Breathlessness (on exertion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of aortic stenosis?

A

Bicuspid aortic valve
Age-related calcification
Rheumatic fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different survival rates depending on the presence of symptoms in aortic stenosis?

A 
Asymptomatic = 1% chance of problems
Symptomatic = 2-5 years before problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do you hear on auscultation for aortic stenosis?

A

Ejection systolic murmur

Radiates to the carotids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the signs of AS on examination?

A

Slow rising character of pulse
Low volume pulse
Narrow pulse pressure
Forceful apex beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can you see on x-ray with AS?

A

Dilated and prominent aorta

Relatively small heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can you see on ECG with AS?

A

Left ventricular hypertrophy

Left ventricular strain pattern (ST depression, T wave inversion in LV leads)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a murmur?

A

Sounds produced by turbulent flow of blood through the heart/abnormal valves.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does inspiration help with identifying murmurs?

A

Deep inspiration means there is increased venous return to the heart. This means that it causes right sided murmurs to increase in intensity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does expiration help with identifying murmurs?

A

Deep expiration means there is an increased afterload from the heart, therefore causing left sided murmurs to be loudeste.g. - aortic stenosis and mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define stenosis

A

Obstruction to the normal flow of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Define regurgitation

A

Failure to prevent the back-flow of blood through the valve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can causes valvular disease?

A

Direct damage to the valve leaflets

Secondary to damage to the papillary muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the major causes of mitral stenosis?

A

Rheumatic fever- some people have calcification due to old age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the major causes of mitral regurgitation?

A 
Rheumatic fever
Mitral valve prolapse
Papillary muscle dysfunction (post MI)
Valve ring dilatation 
Cardiomyopathy
Connective tissue disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the major causes of aortic regurgitation?

A 
Rheumatic fever
Aortic dilatation
Rheumatological disorders
Infective endocarditis 
Bicuspid valve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What occurs as a result of mitral valve calcification?

A

Calcification can causes stiffening of the valve cusps which leads to narrowing of the lumen. This narrowing leads to left ventricular hypertrophy as the muscle has to contract harder in order to force the blood through the narrowed lumen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Define myxomatous degeneration

A

Degeneration of the connective tissue which holds the mitral valve in place. This occurs alongside a build up of dermatan sulfate (a glycosaminoglycan). This degeneration causes prolapse of the valve during systole, causing regurgitation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe rheumatic heart disease

A

Occurs as a result of rheumatic fever - an autoimmune reaction caused by infection with group A streptococci, usually in the throat. Occurs in 5-15 year olds but is becoming rarer in the UK.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where does rheumatic disease have an effect in the body?

A

Heart
Skin
Joints
CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some common symptoms with rheumatic fever?

A

Fever
Arthralgia
Leucocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the pathophysiology of rheumatic disease in the heart?

A

Carditis which causes granulomatous regions in the heart with an area of central necrosis. Initially, there is infiltration of macrophages, lymphocytes and plasma cells. Eventually these will be replaced with fibrous tissue. There can be development of small nodules on mitral valve itself, made up of platelets a fibrin. They are known as Aschoff nodules which are areas of inflammation of connective tissue.

23
Q

Describe infective endocarditis

A

Infection of the endocardium or vascular endothelium. Classed according to the causative organism.

24
Q

Give some characteristics of the valves that are commonly affected by infective endocarditis

A

Previously damaged valves Valves with congenital abnormalities

25
Q

What are some of the main causative agents for infective endocarditis?

A 
Streptococcus viridans
Staphylococcus aureus
Enterococcus faecalis
Coxiella burnetti
Aspergillus
Candida
26
Q

What are the complications of infective endocarditis?

A

Acute valve incompetence
Emboli to the spleen, kidneys and brain
Glomerulonephritis and failure

27
Q

What are the effects of mitral stenosis on the heart?

A

Increased LA pressure causing pulmonary venous and arterial hypertension. This then causes increased back-flow in the lungs which causes right ventricular hypertrophy in order to overcome the pressure in the lungs. Tricuspid regurgitation can then arise from this and ultimately lead to right heart failure.

28
Q

Give some signs of mitral stenosis

A

Atrial fibrillation
Malar flush
Tapping apex beat - due to palpable 1st heart sound

29
Q

What can you hear on auscultation of mitral stenosis?

A

Loud S1
“Opening snap” - high pitched sound just after S2
Rumbling mid-diastolic murmur- best heard with the bell over the apex with the patient lying on their left.

30
Q

What can you see on x-ray with mitral stenosis?

A

Enlarged left atrium

Signs of pulmonary oedema

31
Q

What are the signs of pulmonary oedema on CXR?

A

Bilateral increased lung markings (bat winged shaped)
Kerley B lines
Meniscus sign
Obliteration of hemidiaphragm and costophrenic angle
Blunting of the costophrenic angle

32
Q

What are Kerley B lines?

A

Build up of fluid in the secondary lobules of the lungs.

33
Q

Give some signs of mitral regurgitation

A

Sinus rhythm
Malar flush
Displaced apex beat (volume overload)
Palpable thrill

34
Q

What can you hear on auscultation of mitral regurgitation?

A

Pansystolic murmur

Radiates to the axilla

35
Q

What can you see on xray in mitral regurgitation?

A

Cardiomegaly- due to left atrial and left ventricular enlargement

36
Q

What do you see on ECG with mitral regurgitation?

A

Bifid P waves

Left ventricular hypertrophy

37
Q

Describe the pathology of aortic regurgitation

A

Blood refluxes from the aorta to the left ventricle during diastole. In order to pump out sufficient blood, the cardiac output must increase therefore there needs to be an increase in the size of the left ventricle in order to cope with this.

38
Q

Give some signs of artic regurgitation

A

Collapsing pulse

Displaced apex beat

39
Q

What can you hear on asucultation of aortic regurgitation?

A

High pitched early diastolic murmurBest heard at L sternal edge in the 4th intercostal space with the patient leaning forward and holding their breath in inspiration.

40
Q

What can you see on ECG with aortic regurgitation?

A

Left ventricular hypertrophy

41
Q

What are the three classification of atrial fibrillation?

A
  1. Paroxysmal – intermittent, self-terminating episodes
  2. Persistent – prolonged episodes, terminated by electrical or chemical cardioversion
  3. Permanent
42
Q

What signs would you get with atrial fibrillation?

A
  • Irregularly irregular heart rate

- Hypertension

43
Q

What symptoms can be causes by atrial fibrillation?

A

Palpitation
Breathlessness
Fatigue

44
Q

With which diseases can atrial fibrillation occur?

A
  • Coronary artery disease
  • Valvular heart disease
  • Hypertension
  • Hyperthyroidism
  • Cardiomyopathy
  • Congenital heart disease
  • Idiopathic
  • Pulmonary embolism
  • Chest infection
45
Q

Give the pathology of atrial fibrillation

A

Abnormal autonomic firing and the presence of multiple interacting re-entry loops.

46
Q

Give some causes of an ejection systolic murmur

A 
Aortic stenosis 
Pulmonary stenosis 
HOCM
ASD 
Tetralogy of Fallot
47
Q

What can cause a a pansystolic murmur?

A

Mitral regurgitation
Tricuspid regurgitation
VSD

48
Q

What causes a late systolic murmur?

A

Mitral valve prolapse

Coarctation of the aorta

49
Q

What causes an early diastolic murmur?

A

Aortic regurgitation

Pulmonary regurgitation

50
Q

What causes a mid to late diastolic murmur?

A

Mitral stenosis

Severe aortic regurgitation

51
Q

What causes a continuous machine-like murmur?

A

Patent ductus arteriosus

52
Q

Describe a venous hum

A

Innocent murmur heard in children
Due to turbulent blood flow in the great veins returning to the heart. Continuous blowing noise just below the clavicles.

53
Q

Give some characteristics of an innocent ejection murmur

A 
Varies with posture
Localised, no radiation
No thrill
No added sounds
Asymptomatic child

Phase 2 - Cardioresp (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions