Murmurs and Prosthetic Valves Flashcards
What is S1?
Closing of atrioventricular valves
Mitral and Tricuspid
What is S2?
Closing of the semilunar valves
Aortic and Pulmonary
What can a third heart sound indicate?
15-40 = normal 40+ = ?HF
When is a fourth heart sound heard?
Directly before S1
Indicates stiff/hypetrophic ventricle
caused by turbulent flow from an atria contracting against a non-compliant ventricle
Auscultation: Pulmonary valve
2nd I.C.S left sternal boarder
Auscultation: Aortic valve
2nd I.C.S right sternal boarder
Auscultation: Tricuspid valve
4th I.C.S left sternal boarder
Auscultation: Mitral valve
5th I.C.S mid clavicular line (apex area)
Where are S1 and S2 best heard?
ERb’s point
Third intercostal space on the left sternal boarder
What can be done to emphasise different murmurs?
RILE
Right = Inspiration
Left = Expiration
Patient on left side (mitral stenosis)
Patient learning forward and holding exhalation (aortic regurgitation)
Assessing a murmur
S – Site: where is the murmur loudest?
C – Character: soft / blowing / crescendo (getting louder) / decrescendo (getting quieter) / crescendo-decrescendo (louder then quieter)
R – Radiation: can you hear the murmur over the carotids (AS) or left axilla (MR)?
I – Intensity: what grade is the murmur?
P – Pitch: is it high pitched or low and grumbling? Pitch indicates velocity.
T – Timing: is it systolic or diastolic?
Murmur grading
- Difficult to hear
- Quiet
- Easy to hear
- Easy to hear with a palpable thrill
- Can hear with stethoscope barely touching chest
- Can hear with stethoscope off the chest
What valvular disease causes hypertrophy?
Mitral stenosis - left atrial hypertrophy
Aortic stenosis - left ventricular hypertrophy
What valvular disease causes dilation?
Mitral regurgitation - left atrial dilatation
Aortic regurgitation - left ventricular dilatation
Causes of Mitral stenosis
Rheumatic Heart Disease
Infective Endocarditis
What type of murmur is mitral stenosis?
Mid-diastolic, low pitched “rumbling” murmur
Associations in Mitral stenosis
Malar flush - back-pressure of blood into the pulmonary system causing a rise in CO2 and vasodilation
AF - left atrium struggles to push blood through the stenotic valve causing strain and electrical disruption
What type of murmur is mitral regurgitation?
pan-systolic, high pitched “whistling” murmur
Radiates to left axilla
Causes of mitral regurgitation
Idiopathic weakening of the valve with age
Ischaemic heart disease
Infective Endocarditis
Rheumatic Heart Disease
Connective tissue disorders such as Ehlers Danlos or Marfans
What type of murmur is aortic stenosis?
Ejection-systolic, high pitched murmur
crescendo-decrescendo character
Signs of aortic stenosis
Murmur radiates to the carotids
Slow rising pulse and narrow pulse pressure
Patients may complain of exertional syncope
Causes of aortic stenosis
Idiopathic age related calcification
Rheumatic Heart Disease
What type of murmur is aortic regurgitation?
Early diastolic, soft murmur
Associated with a Corrigan’s pulse
What is an Austin-Flint murmur?
Heard at the apex Early diastolic “rumbling” murmur
Caused by blood flowing back through the aortic valve and over the mitral valve causing it to vibrate
Causes of aortic regurgitation
Idiopathic age related weakness
Connective tissue disorders such as Ehlers Danlos syndrome or Marfan syndrome
Complications with mechanical heart valves
Thrombus formation (blood stagnates and clots) Infective endocarditis (infection in prosthesis) 2.5% Haemolysis
Lifespan of replacement valve
Biosynthetic - 10 years
Mechanical - 20 year (warfarin lifelong)
