Murmurs

Question 1

Define a cardiac murmur

Answer 1

audible turbulence of blood flow that may be innocent or pathological

Question 2

What six questions are used to describe a cardiac murmur?

Answer 2

Systole or diastole?
Type of murmur?
Where is it loudest?
Where does it radiate?
What is its grade?
Influenced by respiration?

Question 3

What causes the first heart sound?

Answer 3

Closure of the mitral and tricuspid valves (start of systole)

Question 4

What causes the second heart sound?

Answer 4

Closure of the aortic and pulmonary valves (start of diastole)

Question 5

Name two murmurs heard in systole

Answer 5

• aortic stenosis

- mitral regurgitation

Question 6

What are the two types of systolic murmur?

Answer 6

Pansystolic - constant sound between S1 and S2

Ejection systolic - crescendo between S1 and S2

Question 7

Name two murmurs that occur in diastole

Answer 7

aortic regurgitation & mitral stenosis

Question 8

What are the two types of diastolic murmur?

Answer 8

early diastolic - starts loud and gets quieter

mid diastolic - rumbling character

Question 9

Where can a murmur radiate to?

Answer 9

Carotids

Axilla

Question 10

Describe the grading of murmurs

Answer 10

I - very quiet
II - quiet 
III - loud 
IV - loud with thrill 
V - very loud with thrill 
VI - loud (audible without a stethoscope)

Question 11

What type of murmur is louder on respiration?

Answer 11

Right sided murmurs

Question 12

Describe an innocent murmur

Answer 12

less than 3/6 severity, position dependent and often early systolic

Question 13

What is valve stenosis?

Answer 13

valves which do not open properly

Question 14

What is valve regurgitation?

Answer 14

valves which do not close properly

Question 15

What is mixed valve disease?

Answer 15

Valves that neither open nor close properly

Question 16

State three causes of aortic stenosis

Answer 16

• degenerative
• congenital
• rheumatic

Question 17

What are the symptoms of aortic stenosis?

Answer 17

SOB, chest pain, dizziness/syncope

Question 18

What are the signs of aortic stenosis?

Answer 18

low volume pulse,
displaced apex beat,
ejection systolic murmur that radiates to the carotids

Question 19

On an ECG what does aortic stenosis look like?

Answer 19

…

Question 20

What are the three treatment options for aortic stenosis?

Answer 20

• conventional valve replacement
• transcatheter aortic valve replacement
• balloon aortic valvotomy

Question 21

Name the two different types of prosthetic heart valves

Answer 21

• mechanical

- bio-prosthetic

Question 22

Describe mechanical prosthetic valves

Answer 22

Last longer, patients require warfarin, used in young patients

Question 23

Describe bio-prosthetic valves

Answer 23

No warfarin required, lasts 10 years, used in older patients

Question 24

Why is valve replace preferred to implantation?

Answer 24

Better long term outcomes and no contraindications, it can be used with CABG.

Question 25

When is TAVI used?

Answer 25

Patients with co-mobidiites or who have had a previous sternotomy

Question 26

State four causes of mitral regurgitation

Answer 26

- leaflets - chordea rupture (degenerative) - papillary muscles rupture (ischaemia) - annular dilatation (functional)

Question 27

What are the symptoms of mitral regurgitation?

Answer 27

SOB, peripheral oedema & fatigue

Question 28

What are the signs of mitral regurgitation?

Answer 28

displaced apex, pan systolic murmur, radiates to axilla

Question 29

Name three treatment options for mitral regurgitation

Answer 29

Medication - diuretics & heart failure (ACEIs) Surgical (repair in prolapse or replace in degenerative) Percutaneous (clips in infancy)

Question 30

What is the main cause of mitral stenosis?

Answer 30

Mainly rheumatic but sometimes congenital

Question 31

What are the symptoms of mitral stenosis?

Answer 31

SOB, fatigue, palpitations (AF)

Question 32

What are the signs of mitral stenosis?

Answer 32

malar flush, tapping of apex beat & mid diastolic rumbling murmur localised to apex

Question 33

Name three treatments for mitral stenosis

Answer 33

- medication - surgery - balloon valvuloplasty

Question 34

What are the two main causes of aortic regurgitation?

Answer 34

- leaflets (endocarditis, connective tissue disease, rheumatic) - annulus (marfans & aortic dissection)

Question 35

What is the main symptom of aortic regurgitation?

Answer 35

Breathlessness

Question 36

What are the signs of aortic regurgitation?

Answer 36

Collapsing pulse, wide pulse pressure, displaced apex beat, early diastolic murmur

Question 37

Name the types of treatment that can be given to a patient with aortic regurgitation

Answer 37

- medication (ACE inhibitor) | - surgery (valve replacement)