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Cardiovascular > Murmurs > Flashcards

Murmurs Flashcards

1
Q

Define a cardiac murmur

A

audible turbulence of blood flow that may be innocent or pathological

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2
Q

What six questions are used to describe a cardiac murmur?

A 
Systole or diastole?
Type of murmur?
Where is it loudest?
Where does it radiate?
What is its grade?
Influenced by respiration?
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3
Q

What causes the first heart sound?

A

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

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4
Q

What causes the second heart sound?

A

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

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5
Q

Name two murmurs heard in systole

A
  • aortic stenosis

- mitral regurgitation

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6
Q

What are the two types of systolic murmur?

A

Pansystolic - constant sound between S1 and S2

Ejection systolic - crescendo between S1 and S2

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7
Q

Name two murmurs that occur in diastole

A

aortic regurgitation & mitral stenosis

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8
Q

What are the two types of diastolic murmur?

A

early diastolic - starts loud and gets quieter

mid diastolic - rumbling character

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9
Q

Where can a murmur radiate to?

A

Carotids

Axilla

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10
Q

Describe the grading of murmurs

A 
I - very quiet
II - quiet 
III - loud 
IV - loud with thrill 
V - very loud with thrill 
VI - loud (audible without a stethoscope)
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11
Q

What type of murmur is louder on respiration?

A

Right sided murmurs

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12
Q

Describe an innocent murmur

A

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

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13
Q

What is valve stenosis?

A

valves which do not open properly

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14
Q

What is valve regurgitation?

A

valves which do not close properly

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15
Q

What is mixed valve disease?

A

Valves that neither open nor close properly

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16
Q

State three causes of aortic stenosis

A
  • degenerative
  • congenital
  • rheumatic
17
Q

What are the symptoms of aortic stenosis?

A

SOB, chest pain, dizziness/syncope

18
Q

What are the signs of aortic stenosis?

A

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

19
Q

On an ECG what does aortic stenosis look like?

A

…

20
Q

What are the three treatment options for aortic stenosis?

A
  • conventional valve replacement
  • transcatheter aortic valve replacement
  • balloon aortic valvotomy
21
Q

Name the two different types of prosthetic heart valves

A
  • mechanical

- bio-prosthetic

22
Q

Describe mechanical prosthetic valves

A

Last longer, patients require warfarin, used in young patients

23
Q

Describe bio-prosthetic valves

A

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

24
Q

Why is valve replace preferred to implantation?

A

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

25
Q

When is TAVI used?

A

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

26
Q

State four causes of mitral regurgitation

A
  • leaflets
  • chordea rupture (degenerative)
  • papillary muscles rupture (ischaemia)
  • annular dilatation (functional)
27
Q

What are the symptoms of mitral regurgitation?

A

SOB, peripheral oedema & fatigue

28
Q

What are the signs of mitral regurgitation?

A

displaced apex, pan systolic murmur, radiates to axilla

29
Q

Name three treatment options for mitral regurgitation

A

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

30
Q

What is the main cause of mitral stenosis?

A

Mainly rheumatic but sometimes congenital

31
Q

What are the symptoms of mitral stenosis?

A

SOB, fatigue, palpitations (AF)

32
Q

What are the signs of mitral stenosis?

A

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

33
Q

Name three treatments for mitral stenosis

A
  • medication
  • surgery
  • balloon valvuloplasty
34
Q

What are the two main causes of aortic regurgitation?

A
  • leaflets (endocarditis, connective tissue disease, rheumatic)
  • annulus (marfans & aortic dissection)
35
Q

What is the main symptom of aortic regurgitation?

A

Breathlessness

36
Q

What are the signs of aortic regurgitation?

A

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

37
Q

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

A
  • medication (ACE inhibitor)

- surgery (valve replacement)

Cardiovascular (19 decks)

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