Murmurs Flashcards
What is S1?
1st heart sound
What causes S1?
AV valves (tricuspid, mitral valves) At the start of systolic contraction
What is S2?
2nd heart sound
What causes S2?
Closing of semi-lunar valves (pulmonary and aortic)
Once systolic contraction is complete
What is S3?
3rd heart sound
Pathological in people older than 40 years
When is S3?
Roughly 0.1s after S2
What causes S3?
Rapid ventricular filling causing chordae tendineae to pull their full length and twang like a guitar string
When is S3 normal?
Ina healthy patient aged 15-40
What does S3 indicate in older patients?
Indicates heart failure
-Ventricles and chordae tendineae reach limit faster
What is S4?
4th heart sound
-Completely abnormal
When is S4?
Heard right before S1
What does S4 indicate?
Hypertrophic ventricle
Caused by turbulent flow from atria contracting against non-compliant ventricle
What part of stethoscope do you hear low sounds with?
Bell
Diaphragm for high
Where do you listen for the Tricuspid valve?
5th ICS, Left sternal border
What valve do you hear over the 2nd ICS, Left border?
Pulmonary valve
Where do you listen for the aortic valve?
2nd ICS, Right sternal border
What is heard over the 5th ICS, mid-clavicular line?
Mitral valve
Where and what is Erb’s point?
3rd ICS on left lateral border
best place to listen for S1&2
What murmur is accentuated when a patient is on their left hand side?
Mitral stenosis (as far left as you can go)
What does sitting a patient up, leaning forward & asking them to hold their exhale test for?
Aortic regurgutation
How to assess a murmur?
SCRIPT
Site: where it is loudest
Character: soft, blowing, crescendo, decrescendo
Radiation: Heard over carotids= AS, left axilla= MR
Intensity: What grade
Pitch: High or low/grumbling
Timing: systolic or diastolic
Grading for murmurs? (not too important)
1= Difficult to hear
2= Quiet
3=Easy to hear
4= Easy to hear + palpable thrill
5= Can hear with stethoscope barely touching chest
6= Can hear with stethoscope off the chest
What two things can valvular disease cause?
Hypertrophy
or of myocardium
Dilation
What chamber does aortic pathology affect?
Left ventricular
Which pathology affects the left atrium?
Mitral pathology
What can Mitral stenosis cause?
LA hypertrophy
What can aortic stenosis cause?
LV hypertrophy
Mitral always relates to which chamber?
LA
Aortic always related to which chamber?
LV
What causes LA dilation?
Mitral regurgitation
Aortic regurgitation causes?
LV dilation
Stenosis murmurs cause hypertrophy. True or False?
True
What do regurgitation murmurs cause?
Dilation
Pathophysiology of mitral stenosis?
Narrow mitral valve making it difficult for LA to push blood through ventricle
What causes mitral stenosis?
Rheumatic heart disease
Infective endocarditis
What mitral stenosis sounds like?
Mid-diastolic low rumbling murmur
-due to low velocity of blood
What situation can mitral stenosis be palpated?
Tapping apex beat
What can mitral stenosis be associated with?
Malar flush: due to ack of pressure of blood into pulmonary system causing rise in CO2& vasodilation
Atrial fibrillation: Caused by LA struggling to push blood through stenotic valve causing strain/electrical disruption resulting in fibrillation
Pathophysiology of mitral regurgitation?
Incompetetant mitral valve allows blood to lead back through during systolic contraction of LV
Causes of mitral regurgitation?
- Idiopathic weakening of valve with age
- Ischaemic heart disease
- Infective endocarditis
- Rheumatic heart disease
- Connective tissue disorders
Example of connective tissue disorders?
Ehlers Danlos syndrome
Marfan syndrome
What does mitral regurgitation sound like?
Pan-systolic high pitched whistling murmur
Does mitral regurgitation radiate?
Yes
To left axilla
What can mitral regurgitation result in?
Congestive heart failure
Because leaking valve causes decreased ejection function & backlog of blood that is waiting to be pumped through LHS of heart
MAY HEAR 3RD HEART SOUND
What might you hear in mitral regurgitation?
3rd heart sound
What is the most common valve disease?
Aortic stenosis
What does aortic stenosis sound like?
Ejection systolic high pitched murmur with crescendo-decrescendo character
Where does aortic stenosis radiate to?
Carotids
Other signs of aortic stenosis?
Slow rising pulse & narrow pulse pressure
Patients may complain of syncope
Causes for aortic stenosis?
Idiopathic age related calcification
Rheumatic heart disease
What does aortic regurgitation sound like?
Early diastolic soft murmur
What is aortic regurgitation associated with?
Corrigans pulse (collapsing pulse)
Causes of aortic regurgitation?
Idiopathic age related weakness
Connective tissue disorders
What does AR result in?
Heart failure due to back pressure of blood waiting to get through the LHS of the heart
What is Corrigan’s pulse?
Rapidly appearing and disappearing pulse @ carotid as blood is pumped out by ventricles & then immediately flows back through aortic valve back into ventricles
What can corrigan’s pulse cause?
Austin flint murmur
What is austin flint murmur?
Early diastolic rumbling murmur
-Heard @ apex
What physiologically is happening in austin flint murmur?
Blood flowing back through aortic valve & over mitral valve
