Murmurs Flashcards
Which is the most common murmur and how does it present?
Aortic stenosis murmur
- high pitched, Ejection systolic murmur
- crescendo decrescendo
- loudest on expiration when patient sits forward
- adiating to carotids
- slow rising pulse
- narrow pulse pressure
patient may complain of exertional syncope
What are the symptoms associated with an aortic stenosis murmur
Old SAD Patients
- syncope - esp exertional
- Angina
- Dyspnoea
What are the causes of an aortic stenosis?
- less than 65 years: bicuspid aortic valve
- over 65: calcification of the aortic valve * most common
- post - rheumatic disease
How do you manage aortic stenosis?
- asymptomatic - observe
- symptomatic - valve replacement (tissue or metal) *
What is mitral regurgitation?
- leaky mitral valve causes blood to flow back into atria during contraction of left ventricle
- results in congestive heart failure: leaking valves cause reduced ejection fraction and back log of blood waiting to be pumped through left side of heart
How does a mitral regurg present?
- whistling (high pitched) pan systolic murmur/ holosystolic murmur
- loudest in mitral area using bell
- murmur radiates to left axilla
- loudest on expiration lying on the left
- displaced hyperdynamic apex beat
*soft s1 and wide split s2
What causes mitral regurg?
Management
Age related, congenital, cardiovascular
- Idiopathic weakening of the valve with age
- Ischaemic heart disease
- Infective Endocarditis
- Rheumatic Heart Disease
- Connective tissue disorders: Ehlers Danlos syndrome or Marfan syndrome
Medical - nitrates, diuretics, positive inotropes (digoxin), valvuloplasty
severe heart failure - ACE-I along with beta blockers and spirnolactone
acute severe - surgery. ideally repair, otherwise replace
What is mitral stenosis?
Narrowing of the mitral valve - leads to difficulty pushing blood through the valve
What causes mitral stenosis?
Rheumatic fever, rheumatic fever, rheumatic fever
Infective endocarditis
How does a mitral stenosis present?
- Low rumbling mid diastolic
- Loud S1 sound (due to thick valves needing high pressure to shut then shutting suddenly)
- snapping sound when valve opens
- can palpate a tapping apex beat due to loud S1
- Loudest on inspiration
- Malar flush - rise in back pressure into the circulatory system causing rise in C02 and vasodilation
- Atrial fibrillation - left atrium struggles to push blood through stenotic valve - strain and electrical disruption –> fribrillation
What is a sign of severe mitral stenosis?
- murmur gets longer
- opening snap becomes closer to S2 sound
How does Aortic regurgitation present?
- Early diastolic, high pitched, blowing character
- Corrigan’s pulse/collapsing pulse (rapidly appearing and disappearing pulse at carotid as blood is pumped out by the ventricle then immediately flows back in
- wide pulse pressure
- De Musset’s sign (head bobbing)
What are the causes of aortic regurgitation?
Ehler Danlos syndrome
Marfan’s syndrome
Aortic dissection
