murmurs

Question 1

Describe the first heart sound

Answer 1

It is caused by the closing of the atrioventricular valves (tricuspid and mitral) at the start of systolic contraction of the ventricles

Question 2

Describe the second heart sound

Answer 2

It is caused by the closing of the semilunar valves (the pulmonary and aortic valves) once the systolic contraction is complete

Question 3

Describe the third heart sound

Answer 3

Heard roughly 0.1 seconds after the second heart sound. It can be normal in young (15-40) healthy people. In older patients it can indicate heart failure, as the ventricles and chordae are stage and weak so they reach their limit much faster than normal

Question 4

Describe the fourth heart sound

Answer 4

s4 is heard directly before S1. This is always abnormal and relatively rare to hear. It indicates a stiff or hypertrophic ventricle and is caused by turbulent glow from an atria contacting against a non-compliant ventricle

Question 5

Where is the pulmonary area?

Answer 5

2nd ICS. left sternal border

Question 6

Where is the aortic area?

Answer 6

2nd ICS, right sternal border

Question 7

Where is the tricuspid area?

Answer 7

5th ICS, left sternal border

Question 8

Where is the mitral area?

Answer 8

5th ICS, mid clavicular line

Question 9

Where is Erb’s point and what is it the best area for?

Answer 9

THe 3rd ICS on the left sternal border and is the best area for listening to S! and S2

Question 10

What is the manoeuvre for mitral stenosis?

Answer 10

Patient on their left hand side

Question 11

What is the manoeuvre for aortic regurgitation?

Answer 11

Patient sat up, leaning forward and holding exhalation

Question 12

How should a murmur be assessed?

Answer 12

SCRIPT
Site - where is the murmur the loudest?
Character -
Radiation
Intensity
Pitch 
Timing - systolic / diastolic

Question 13

How are murmurs graded?

Answer 13

1. Difficult to hear
2. Quiet
3. Easy to hear
4. Easy to hear with palpable thrill
5. Can hear with stethoscope barely touching chest
6. Can hear with stethoscope off the chest

Question 14

What does mitral stenosis cause?

Answer 14

Left atrial hypertrophy

Question 15

What does aortic stenosis cause?

Answer 15

Left ventriclular hypertrophy

Question 16

What does mitral regurgitation cause?

Answer 16

Left atrial dilatation

Question 17

What does aortic regurgitation cause?

Answer 17

Left ventricular dilatation

Question 18

What is mitral stenosis caused by?

Answer 18

Rheumatic heart disease

Infective endocarditis

Question 19

What sort of murmur does mitral stenosis cause?

Answer 19

It causes a mid-diastolic, low pitched “rumbling” murmur. There will be a loud S1 due to thick valves requiring a large systolic force to shut, the shutting suddenly. You can palpate a tapping apex beat due to loud S1

Question 20

What is mitral stenosis association with?

Answer 20

Malar flush

Atrial fibrilation

Question 21

What does mitral regurgitation cause?

Answer 21

Congestive cardiac failure because the leaking valve causes a reduced ejection fraction and a backlog of blood the IS waiting to be pumped through the left side of the heart

Question 22

What sort of murmur does mitral regurgitation cause?

Answer 22

A pan-systolic high pitched “whistling” murmur. the murmur radiates to the left axilla, may hear a third heart sound

Question 23

What are the causes of mitral regurgitation?

Answer 23

Idiopathic weakening with age
ischaemic heart disease
Infective endocarditis 
Rheumatic heart disease
Connective tissue disorders - Ehlers DAnlos or marfan's

Question 24

What sort of murmur does aortic stenosis cause?

Answer 24

An ejection-systolic high pitched murmur. This has a crescendo-decrescendo character.

Question 25

What are sigs of aortic stenosis?

Answer 25

The murmur radiates to the carotids as the turbulence continues into the neck.
slow rising pulse and narrow pulse pressure
Patients may have exertion syncope

Question 26

What are the causes of aortic stenosis>

Answer 26

Idiopathic age related calcification

rheumatic heart disease

Question 27

What sort of murmur does aortic regurgitation cause?

Answer 27

an early diastolic, soft murmur.

Question 28

What are the other signs of aortic regurgitation?

Answer 28

collapsing pulse

austin flint murmur (early diastolic murmur over the apex)

Question 29

What does aortic regurgitation cause?

Answer 29

Heart failure

Question 30

What causes aortic regurgitation?

Answer 30

Idiopathic age related weakness

Connective tissue disorders