Murmurs Flashcards
What group of valves closing causes the S1 heart sound?
Atrioventricular valves
What group of valves closing causes the S2 heart sound?
Semilunar valves
What causes the S3 heart sound and when is it normal vs abnormal?
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)
What’s S4, what causes S4 and is it abnormal?
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
Where on the chest do you listen to hear the four valves?
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
Where do you listen on the chest for S3 and what is the area called?
Erb’s point
3rd I.C.S left sternal border
What murmur is best listened to with the patient lying on their left hand side?
Mitral stenosis
What murmur is heard best with the patient sitting up leaning forward and holding exhalation?
Aortic regurgitation
How do you assess a murmur?
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
Explain the grading of murmurs from grade 1 to 6
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
What murmur results in left atrial hypertrophy?
Mitral stenosis
What murmur results in left ventricular hypertrophy?
Aortic stenosis
What murmur causes left atrial dilation?
Mitral regurgitation
What murmur causes left ventricular dilation?
Aortic regurgitation
What are the two common causes of mitral stenosis?
Rheumatic heart disease
Infective endocarditis
What is the timing, pitch and character of mitral stenosis?
Mid-diastolic
Low pitched
Rumbling
What heart sound is louder in mitral stenosis?
S1
What symptom and heart problem is mitral stenosis associated with?
Malar flush
due to back pressure of blood into pulmonary system causing a rise in CO2 and vasodilation
Atrial fibrillation
What is the timing, pitch and character of mitral regurgitation?
Pan systolic
High pitch
Whistling
What murmur may you hear S3 in?
Mitral regurgitation
What are the causes of mitral regurgitation?
Idiopathic weakening of valve with age
Ischaemic heart disease
Infective endocarditis
Rheumatic heart disease
Connective tissue disorders like ehler’s danlos and marfans
What is the timing, pitch and character of aortic stenosis?
Ejection systolic, high pitched, crescendo-decrecendo (louder then quieter)
Where do aortic stenosis murmurs radiate?
Carotids
What are the causes of aortic stenosis?
Idiopathic age related calcification
Rheumatic heart disease
What signs and common symptom do patients complain of in aortic stenosis?
Signs:
Slow rising pulse
Narrow pulse pressure
Symptom:
Exertional syncope
What is the timing and character of aortic regurgitation?
Early diastolic, soft
What sign is aortic regurgitation associated with on examination?
Collapsing/Corrigan’s pulse
What other murmur can aortic regurgitation cause?
Austin flint murmur
What are the causes of aortic regurgitation?
Idiopathic age related weakness
Connective tissue disorders like ehler’s danlos or marfans
What is the pitch, timing of tricuspid regurgitation and where does it radiate to?
High pitched, pan systolic, radiates to right lower sternal border
Where on the chest is it best to listen to tricuspid regurgitation?
Left lower sternal border
What are the causes of tricuspid regurgitation?
Infective endocarditis (common)
Rheumatic heart disease (common)
Congenital heart defect called ebstein anomaly
Carcinoid tumours
Rheumatoid arthritis
Radiation therapy
