Murmurs

Question 1

What is S1?

Answer 1

1st heart sound

Question 2

What causes S1?

Answer 2

AV valves (tricuspid, mitral valves)
At the start of systolic contraction

Question 3

What is S2?

Answer 3

2nd heart sound

Question 4

What causes S2?

Answer 4

Closing of semi-lunar valves (pulmonary and aortic)

Once systolic contraction is complete

Question 5

What is S3?

Answer 5

3rd heart sound

Pathological in people older than 40 years

Question 6

When is S3?

Answer 6

Roughly 0.1s after S2

Question 7

What causes S3?

Answer 7

Rapid ventricular filling causing chordae tendineae to pull their full length and twang like a guitar string

Question 8

When is S3 normal?

Answer 8

Ina healthy patient aged 15-40

Question 9

What does S3 indicate in older patients?

Answer 9

Indicates heart failure

-Ventricles and chordae tendineae reach limit faster

Question 10

What is S4?

Answer 10

4th heart sound

-Completely abnormal

Question 11

When is S4?

Answer 11

Heard right before S1

Question 12

What does S4 indicate?

Answer 12

Hypertrophic ventricle

Caused by turbulent flow from atria contracting against non-compliant ventricle

Question 13

What part of stethoscope do you hear low sounds with?

Answer 13

Bell

Diaphragm for high

Question 14

Where do you listen for the Tricuspid valve?

Answer 14

5th ICS, Left sternal border

Question 15

What valve do you hear over the 2nd ICS, Left border?

Answer 15

Pulmonary valve

Question 16

Where do you listen for the aortic valve?

Answer 16

2nd ICS, Right sternal border

Question 17

What is heard over the 5th ICS, mid-clavicular line?

Answer 17

Mitral valve

Question 18

Where and what is Erb’s point?

Answer 18

3rd ICS on left lateral border

best place to listen for S1&2

Question 19

What murmur is accentuated when a patient is on their left hand side?

Answer 19

Mitral stenosis (as far left as you can go)

Question 20

What does sitting a patient up, leaning forward & asking them to hold their exhale test for?

Answer 20

Aortic regurgutation

Question 21

How to assess a murmur?

Answer 21

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

Question 22

Grading for murmurs? (not too important)

Answer 22

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

Question 23

What two things can valvular disease cause?

Answer 23

Hypertrophy
or of myocardium
Dilation

Question 24

What chamber does aortic pathology affect?

Answer 24

Left ventricular

Question 25

Which pathology affects the left atrium?

Answer 25

Mitral pathology

Question 26

What can Mitral stenosis cause?

Answer 26

LA hypertrophy

Question 27

What can aortic stenosis cause?

Answer 27

LV hypertrophy

Question 28

Mitral always relates to which chamber?

Answer 28

LA

Question 29

Aortic always related to which chamber?

Answer 29

LV

Question 30

What causes LA dilation?

Answer 30

Mitral regurgitation

Question 31

Aortic regurgitation causes?

Answer 31

LV dilation

Question 32

Stenosis murmurs cause hypertrophy. True or False?

Answer 32

True

Question 33

What do regurgitation murmurs cause?

Answer 33

Dilation

Question 34

Pathophysiology of mitral stenosis?

Answer 34

Narrow mitral valve making it difficult for LA to push blood through ventricle

Question 35

What causes mitral stenosis?

Answer 35

Rheumatic heart disease | Infective endocarditis

Question 36

What mitral stenosis sounds like?

Answer 36

Mid-diastolic low rumbling murmur | -due to low velocity of blood

Question 37

What situation can mitral stenosis be palpated?

Answer 37

Tapping apex beat

Question 38

What can mitral stenosis be associated with?

Answer 38

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

Question 39

Pathophysiology of mitral regurgitation?

Answer 39

Incompetetant mitral valve allows blood to lead back through during systolic contraction of LV

Question 40

Causes of mitral regurgitation?

Answer 40

- Idiopathic weakening of valve with age - Ischaemic heart disease - Infective endocarditis - Rheumatic heart disease - Connective tissue disorders

Question 41

Example of connective tissue disorders?

Answer 41

Ehlers Danlos syndrome | Marfan syndrome

Question 42

What does mitral regurgitation sound like?

Answer 42

Pan-systolic high pitched whistling murmur

Question 43

Does mitral regurgitation radiate?

Answer 43

Yes | To left axilla

Question 44

What can mitral regurgitation result in?

Answer 44

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

Question 45

What might you hear in mitral regurgitation?

Answer 45

3rd heart sound

Question 46

What is the most common valve disease?

Answer 46

Aortic stenosis

Question 47

What does aortic stenosis sound like?

Answer 47

Ejection systolic high pitched murmur with crescendo-decrescendo character

Question 48

Where does aortic stenosis radiate to?

Answer 48

Carotids

Question 49

Other signs of aortic stenosis?

Answer 49

Slow rising pulse & narrow pulse pressure | Patients may complain of syncope

Question 50

Causes for aortic stenosis?

Answer 50

Idiopathic age related calcification | Rheumatic heart disease

Question 51

What does aortic regurgitation sound like?

Answer 51

Early diastolic soft murmur

Question 52

What is aortic regurgitation associated with?

Answer 52

Corrigans pulse (collapsing pulse)

Question 53

Causes of aortic regurgitation?

Answer 53

Idiopathic age related weakness | Connective tissue disorders

Question 54

What does AR result in?

Answer 54

Heart failure due to back pressure of blood waiting to get through the LHS of the heart

Question 55

What is Corrigan's pulse?

Answer 55

Rapidly appearing and disappearing pulse @ carotid as blood is pumped out by ventricles & then immediately flows back through aortic valve back into ventricles

Question 56

What can corrigan's pulse cause?

Answer 56

Austin flint murmur

Question 57

What is austin flint murmur?

Answer 57

Early diastolic rumbling murmur | -Heard @ apex

Question 58

What physiologically is happening in austin flint murmur?

Answer 58

Blood flowing back through aortic valve & over mitral valve