Murmurs Flashcards
When will you hear a Decrescendo early diastolic murmur?
Aortic regurg
Name signs that are associated with Aortic regurg?
Corrigan’s sign De Musset’s sign Quincke’s sign Duroziez’s sign Traube’s sign Muller’s sign
What is quincke’s sign?
pulsations are seen in the nail bed with each heartbeat when nail bed is lightly compressed
Austin Flint murmur is a sign of?
severe aortic regurg
What is corrigan’s sign?
visible distention and collapse of carotid arteries in the neck
Where do you hear an austin flint murmur?
How is this site different to normal aortic regurg site?
What does it sound like?
low pitched rumbling mid-diastolic murmur heard best at the apex (as opposed to left sternal edge)
What is de musset sign?
head bobbing with each heartbeat
what is duroziez sign?
stethoscope placed over femoral arteries. When gentle pressure is applied proximal to the stethoscope a systolic murmur is heard;
what is mullers sign?
Pistol shot’ sound heard when stethoscope placed over the femoral artery during systole and diastole
what is traube sign?
Pistol shot’ sound heard when stethoscope placed over the femoral artery during systole and diastole
Low-volume pulse which may be irregularly, irregular is common in which valvular disorder?
therefore which condition is common in this disorder?
mitral stenosis
Atrial fibrillation
Which disorder do you see a Mid-systolic click
Followed by a mid or late-systolic murmur
Mitral valve prolapse
which disorder do you see Large ‘v-waves’ in JVP
tricuspid regurg
Name 4 signs of right heart failure
Right ventricular heave
Peripheral oedema
Hepatomegaly
Ascites
Loud first heart sound with tapping apex beat is seen in what?
mitral stenosis
Prominent ‘a waves’ in JVP is seen when?
meaning?
pulmonary stenosis
and less often in tricuspid stenosis
occur because there is resistance to rt atrial contraction
What is the aetiology of a widely split S2 wave?
Widely split S2 – blood from the ventricles takes longer to pass through a narrow pulmonary valve, so pulmonary valve closure occurs much later than aortic valve closure
Pulmonary stenosis can cause?
Which can lead to what signs?
Right ventricular dilatation thus;
Right ventricular heave
Tricuspid regurgitation
Peripheral signs of right-sided heart failure
Which murmur is associated with pulmonary regurg and cor pulmonale?
Graham Steell murmur - early diastolic decrescendo high pitched murmur
it is called this (as opposed to just early diastolic) when associated with mitral stenosis
you see Raised JVP with giant ‘a waves’ when?
tricuspid stenosis
Signs of pulmonary htn?
malar flush
graham steel murmur
right sternal heave
4 causes of tricuspid regurg
Right ventricular dilatation
Rheumatic fever
Infective endocarditis
Congenital e.g. atrial septal defect,
4 causes of aortic regurg
Rheumatological disorders; SLE, Rheum arthritis
Infective endocarditis
Prosthetic aortic valve failure
Connective tissue disease (e.g. Marfan syndrome, Ehlers-Danlos syndrome)
4 causes of mitral regurg
Infective endocarditis
Left ventricular dilatation
Mitral valve prolapse
Connective tissue disease
2 causes of aortic stenosis?
Degenerative age-related calcification (commonest cause)
Bicuspid aortic valve (important cause in a young person with aortic steno
4 causes of mitral stenosis?
what is the most common cause?
Rheumatic heart disease (commonest cause of mitral stenosis worldwide)
Congenital
Left atrial myxoma (bening tumour on atrial septum)
Connective tissue disorders; marfans, ehlers danlos
2 causes of pulmonary stenosis?
Congenital; Turner’s
Rheumatic fever
Mmemonic for the 3rd heart sound?
What is the cause?
When does S3 come?
Kentucky
Rapid ventricular filling
After s2 (1, 23)
Mmemonic for the 4th heart sound?
What is the cause?
When does S4 come?
Tennessee
Atrium contracting against a stiff ventricle (due to htn)
Just before S1 (4, 12)
What is a summation gallop / gallop rhythm?
When do you hear it?
Sound?
When both 3rd and 4th heart sounds are present
End stage heart failure
Sound; 4, 123
Intrathoric pressure drops on inspiration, what else is supposed to drop?
If this doesnt drop but rises instead, what is this sign called?
JVP
Kussmaul’s sign
In which conditions do we see Kussmaul’s sign and why?
- Constrictive pericarditis
- restrictive cardiomyopathy
- cardiac tamponade
because these limit right ventricular filling due to exerting pressure
What is the mmemonic for causes of raised jvp?
PQRST
What does PQRST stand for?
- in relation to raised jvp
P-Pericardial effusion, Pulmonary embolism, Pulmonary hypertension (chronic)
Q-Quantity of fluid (fluid overload)
R-Right heart failure
S-Superior venacaval obstruction
- (distended veins without pulsation)
T-Tricuspid regurgitation, Tricuspid stenosis, Tamponade (cardiac)
Symptoms of Mitral stenosis?
SOB + palpitations
Malar flush
slow rising pulse
Loud 1st HS +- an opening snap
ECG:
P mitrale - bifid p wave
RVH
Atrial fibrillation
CXR:
Smaller heart?
pulmonary hypertension/ venous congestion?
MX of Mitral stenosis?
Anticoagulation and treat AF
In order;
- Percutaneous mitral valvulostomy
- Open mitral valvotomy - open surgery for heavily calcified valve
- Replace valve with prosthesis
Main sx of mitral regurg?
SOB !
PND, fatigue etc
IVX findings of Mitral regurg?
ECG:
SR/AF
LVH
CXR:
Cardiomegaly
pulmonary congestion/oedema
Mx for mitral regurg?
Valvular Repair, Replacement, Clipping
hope youve realised that elevated jvp is assocaited with which valvular issues?
right sided - tricuspid and pulmonary
What are cannon waves or cannon a waves and their meaning?
cannon atrial waves, are waves seen occasionally in the jugular vein of humans with certain cardiac arrhythmias.
When the atria and ventricles happen to contract simultaneously, the right atrium contracts against a closed tricuspid valve,
resulting in back pressure into the venous system that can be seen in the jugular venous pulse as a high-amplitude “cannon wave”
Not the same as “a waves”
causes of cannon waves?
They occur irregularly in complete heart block and ventricular tachycardia,
presentation of cannon waves?
may have also: headache, cough, and jaw pain
arrythmia that lead to the cannon waves; palpitation and SOB - abrupt onset?
