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Year 3 Cardiology > Murmurs > Flashcards

Murmurs Flashcards

1
Q

Which murmurs are increased with inspiration

A

Right sided

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2
Q

Which murmurs are increased with expiration

A

Left sided

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3
Q

Systolic murmurs

A

Aortic stenosis
Mitral regurgitation
Tricuspid regurgitation

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4
Q

Diastolic murmurs

A

Aortic regurgitation

Mitral stenosis

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5
Q

Aortic stenosis on auscultation

A

Crescendo decrescendo systolic ejection murmur - exaggerated by sitting forward

Radiates to carotids

Soft S2 in very severe cases

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6
Q

Presentation of aortic stenosis

A

SAD:
Syncope
Angina
Dyspnoea

Dizziness 
Decreased pulse rate - slow rising pulse 
Aortic thrill
Murmur 
Hypotension
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7
Q

Causes of aortic stenosis

A

Age related degeneration/ calcification
Congenital bicuspid valve - ejection click
Rheumatic fever - commiserate fusion

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8
Q

Consequences of aortic stenosis

A
  • Increased end systolic volume causing LV hypertrophy causing LVHF
  • microangiopathic haemolytic anaemia
  • dizziness/LOC causing falls
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9
Q

Causes of aortic regurgitation

A 
BEAR: 
Bicuspid aortic valve 
Endocarditis -Pupillary muscle or chordae tendinae degeneration 
Aortic root dilation 
Rheumatic fever

Other:
Marfans syndrome
Type A aortic dissection

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10
Q

Consequences of aortic regurgitation

A

Increased end systolic volume causing LV hypertrophy - LVHF

Increased systolic pressure and decreased end diastolic pressure - increased pulse pressure

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11
Q

Signs of aortic regurgitation

A
  • Early decrescendo murmur - ejection systolic murmur
  • Corrigan’s pulse - Collapsing pulse
  • De musset’s sign - - bobbing head
  • quinke’s sign - capillary pulsation in nail bed
  • water hammer pulse - hyperdynamic
LVF:
Exertional dyspnoea
PND
Orthopnoea
Angina
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12
Q

Causes of mitral regurgitation

A 
Myxomatous degeneration 
Post MI pupillary muscle damage 
LVHF - left ventricular dilatation stretches valve 
Rheumatic heart failure
Marfans
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13
Q

Mitral regurgitation murmur

A

Holosystolic or pansystolic
Loudest at apex
Radiates to axilla

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14
Q

Causes of mitral stenosis

A

Rheumatic fever - commisural fusion of leaflets

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15
Q

Consequences of mitral stenosis

A 
Left atrium dilation - compresses oesophagus causing dysphagia 
AF - can cause thrombus formation 
Pulmonary oedema - dyspnoea 
Pulmonary hypertension 
RV hypertrophy - RVHF
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16
Q

Mitral stenosis murmur

A

Diastolic rumble

17
Q

Ortner syndrome

A

Hoarseness of voice due to compression of recurrent laryngeal nerve and dysphagia

18
Q

Causes of tricuspid regurgitation

A

Right ventricular dilatation due to RVHF
IVDU
Rheumatic fever
Infective endocarditis

19
Q

Which organisms causing IE commonly affect the tricuspid valve?

A

Staph aureus
Pseudomonas
Candida

20
Q

Relevant Investigations

A

Observations
Bloods - FBC, U+Es, LFTs, CRP - rheumatic fever
ECG
Echocardiogram

21
Q

Management of aortic stenosis

A
  1. Minimise RF
    - statins
    - anti hypertensives
    - diabetes control
  2. Regular follow ups with echocardiogram
  3. If angina - beta blocker (avoid nitrates)
  4. If HF - furosemide and ACEi
  5. Surgery
22
Q

Commonest causes of valvular heart disease in general

A 
Previous MI 
Rheumatic fever 
Infective endocarditis 
Congenital 
Age - deterioration and calcification
23
Q

Clinical signs of mitral stenosis

A

Malar flush
Early diastolic opening snap - diastolic rumble
Radiation to axilla

24
Q

Mitral regurgitation signs

A

Left parasternal heave
Displaced apex beat if volume overloaded
Pansystolic murmur

25
Q

What clinical signs to check for if suspicions of infective endocarditis

A

Dental hygiene
Roth’s spots - eye
Janeway lesions - painless on palm
Osler’s nodes - painful in finger

26
Q

Common pathogens causing infective endocarditis

A

Strep viridans
Staph aureus
Staph epidermidis

27
Q

Investigations for murmurs

A

Bloods: FBC, U+E, lipids, glucose
ECG: Left ventricular hypertrophy
CXR - calcified AV
Echo doppler - diagnostic

28
Q

Conservative mx for aortic stenosis

A 
Medical:
Optimise RFs: statins, anti-hypertensives, DM
Monitor: regular follow up with echo
Angina: β-B
Heart failure: ACEi and diuretics
Avoid nitrates
29
Q

Indications for valve replacement

A

Severe symptomatic AS
Severe asymptomatic AS with ↓ EF (<50%)
Severe AS undergoing coronary artery bypass graft or other valve operation

30
Q

Valve types

A

Mechanical valves:

  • last longer
  • need anticoagulation: young pts.
Bioprosthetic 
- don’t require anticoagulation but
fail sooner (10-15yrs)
31
Q

Transcatheter Aortic Valve Implantation (TAVI)

A

Folded valve deployed in aortic root.
↑ perioperative stroke risk compared with replacement
↓ major bleeding

32
Q

Aortic regurgitation on CXR

A

Cardiomegaly
Dilated ascending aorta
Pulmonary oedema

33
Q

Signs of mitral stenosis

A
  • ↑ left atrial pressure → loud S1
  • Atrial hypertrophy → AF
  • pulmonary oedema and PHT → loud P2
  • RVH → left parasternal heave
  • RHF → ↑JVP, oedema, ascites, Malar flush
  • Atrial dilation - Dysphagia, hoarse voice, dyspnoea

Year 3 Cardiology (11 decks)

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