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Cardiology > Murmurs > Flashcards

Murmurs Flashcards

1
Q

What group of valves closing causes the S1 heart sound?

A

Atrioventricular valves

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2
Q

What group of valves closing causes the S2 heart sound?

A

Semilunar valves

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3
Q

What causes the S3 heart sound and when is it normal vs abnormal?

A

Caused by rapid ventricular filling causing the chordae tendinae to pull and “twang” like a guitar string.

Can be normal in 15-40 year olds

Abnormal in older people (indicates heart failure)

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4
Q

What’s S4, what causes S4 and is it abnormal?

A

Yes, abnormal

S4 is directly before S1.

Indicates stiff or hypertrophic ventricle

Caused by turbulent flow from an atria contracting against a non compliant ventricle

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5
Q

Where on the chest do you listen to hear the four valves?

A

Pulmonary: 2nd I.C.S left sternal border

Aortic: 2nd I.C.S right sternal border

Tricuspid: 5th I.C.S left sternal border

Mitral: 5th I.C.S mid clavicular line

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6
Q

Where do you listen on the chest for S3 and what is the area called?

A

Erb’s point

3rd I.C.S left sternal border

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7
Q

What murmur is best listened to with the patient lying on their left hand side?

A

Mitral stenosis

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8
Q

What murmur is heard best with the patient sitting up leaning forward and holding exhalation?

A

Aortic regurgitation

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9
Q

How do you assess a murmur?

A

SCRIPT

S- Site, where is the murmur it’s loudest
C- Character, soft/blowing/crescendo etc
R- Radiation 
I- Intensity, what grade is it
P- Pitch (pitch indicates velocity)
T- Timing, is it systolic or diastolic

When presenting a murmur, use C, I, T, P, S, R, then give your diagnosis of what murmur it is

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10
Q

Explain the grading of murmurs from grade 1 to 6

A

1: Difficult to hear
2: Quiet
3: Easy to hear
4: Easy to hear with a palpable thrill
5: Can hear with stethoscope barely touching the chest
6: Can hear with stethoscope off chest

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11
Q

What murmur results in left atrial hypertrophy?

A

Mitral stenosis

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12
Q

What murmur results in left ventricular hypertrophy?

A

Aortic stenosis

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13
Q

What murmur causes left atrial dilation?

A

Mitral regurgitation

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14
Q

What murmur causes left ventricular dilation?

A

Aortic regurgitation

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15
Q

What are the two common causes of mitral stenosis?

A

Rheumatic heart disease

Infective endocarditis

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16
Q

What is the timing, pitch and character of mitral stenosis?

A

Mid-diastolic
Low pitched
Rumbling

17
Q

What heart sound is louder in mitral stenosis?

A

S1

18
Q

What symptom and heart problem is mitral stenosis associated with?

A

Malar flush
due to back pressure of blood into pulmonary system causing a rise in CO2 and vasodilation

Atrial fibrillation

19
Q

What is the timing, pitch and character of mitral regurgitation?

A

Pan systolic
High pitch
Whistling

20
Q

What murmur may you hear S3 in?

A

Mitral regurgitation

21
Q

What are the causes of mitral regurgitation?

A

Idiopathic weakening of valve with age

Ischaemic heart disease

Infective endocarditis

Rheumatic heart disease

Connective tissue disorders like ehler’s danlos and marfans

22
Q

What is the timing, pitch and character of aortic stenosis?

A

Ejection systolic, high pitched, crescendo-decrecendo (louder then quieter)

23
Q

Where do aortic stenosis murmurs radiate?

A

Carotids

24
Q

What are the causes of aortic stenosis?

A

Idiopathic age related calcification

Rheumatic heart disease

25
Q

What signs and common symptom do patients complain of in aortic stenosis?

A

Signs:
Slow rising pulse
Narrow pulse pressure

Symptom:
Exertional syncope

26
Q

What is the timing and character of aortic regurgitation?

A

Early diastolic, soft

27
Q

What sign is aortic regurgitation associated with on examination?

A

Collapsing/Corrigan’s pulse

28
Q

What other murmur can aortic regurgitation cause?

A

Austin flint murmur

29
Q

What are the causes of aortic regurgitation?

A

Idiopathic age related weakness

Connective tissue disorders like ehler’s danlos or marfans

30
Q

What is the pitch, timing of tricuspid regurgitation and where does it radiate to?

A

High pitched, pan systolic, radiates to right lower sternal border

31
Q

Where on the chest is it best to listen to tricuspid regurgitation?

A

Left lower sternal border

32
Q

What are the causes of tricuspid regurgitation?

A

Infective endocarditis (common)

Rheumatic heart disease (common)

Congenital heart defect called ebstein anomaly

Carcinoid tumours

Rheumatoid arthritis

Radiation therapy

Cardiology (13 decks)

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