murmurs Flashcards
Describe the first heart sound
It is caused by the closing of the atrioventricular valves (tricuspid and mitral) at the start of systolic contraction of the ventricles
Describe the second heart sound
It is caused by the closing of the semilunar valves (the pulmonary and aortic valves) once the systolic contraction is complete
Describe the third heart sound
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
Describe the fourth heart sound
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
Where is the pulmonary area?
2nd ICS. left sternal border
Where is the aortic area?
2nd ICS, right sternal border
Where is the tricuspid area?
5th ICS, left sternal border
Where is the mitral area?
5th ICS, mid clavicular line
Where is Erb’s point and what is it the best area for?
THe 3rd ICS on the left sternal border and is the best area for listening to S! and S2
What is the manoeuvre for mitral stenosis?
Patient on their left hand side
What is the manoeuvre for aortic regurgitation?
Patient sat up, leaning forward and holding exhalation
How should a murmur be assessed?
SCRIPT Site - where is the murmur the loudest? Character - Radiation Intensity Pitch Timing - systolic / diastolic
How are murmurs graded?
- Difficult to hear
- Quiet
- Easy to hear
- Easy to hear with palpable thrill
- Can hear with stethoscope barely touching chest
- Can hear with stethoscope off the chest
What does mitral stenosis cause?
Left atrial hypertrophy
What does aortic stenosis cause?
Left ventriclular hypertrophy
What does mitral regurgitation cause?
Left atrial dilatation
What does aortic regurgitation cause?
Left ventricular dilatation
What is mitral stenosis caused by?
Rheumatic heart disease
Infective endocarditis
What sort of murmur does mitral stenosis cause?
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
What is mitral stenosis association with?
Malar flush
Atrial fibrilation
What does mitral regurgitation cause?
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
What sort of murmur does mitral regurgitation cause?
A pan-systolic high pitched “whistling” murmur. the murmur radiates to the left axilla, may hear a third heart sound
What are the causes of mitral regurgitation?
Idiopathic weakening with age ischaemic heart disease Infective endocarditis Rheumatic heart disease Connective tissue disorders - Ehlers DAnlos or marfan's
What sort of murmur does aortic stenosis cause?
An ejection-systolic high pitched murmur. This has a crescendo-decrescendo character.
What are sigs of aortic stenosis?
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
What are the causes of aortic stenosis>
Idiopathic age related calcification
rheumatic heart disease
What sort of murmur does aortic regurgitation cause?
an early diastolic, soft murmur.
What are the other signs of aortic regurgitation?
collapsing pulse
austin flint murmur (early diastolic murmur over the apex)
What does aortic regurgitation cause?
Heart failure
What causes aortic regurgitation?
Idiopathic age related weakness
Connective tissue disorders