Murmurs and valvular diseases Flashcards
Valvular heart disease can cause hypertrophy and dilatation of the myocardium, what do both of these terms mean?
Hypertrophy = thickening both outwards and into the chamber
Dilatation = thinning and expanding
1) Does blood pushing against a stenotic valve cause hypertrophy or dilatation?
2) Does a a leaky valve which allows blood to flow back into a chamber result in hypertrophy or dilatation?
1) Hypertrophy
2) Dilatation
1) Hypertrophy of what does aortic stenosis cause?
2) Hypertrophy of what does mitral stenosis cause?
3) Dilatation of what does aortic regurgitation cause?
4) Dilatation of what does mitral regurgitation cause?
1) Left ventricle
2) Left atrium
3) Left ventricle
4) Left atrium
1) How can ejection systolic murmurs be described?
2) Name a cause of an ejection systolic murmur
1) Crescendo-decrescendo
2) Aortic stenosis, aortic sclerosis, pulmonary stenosis
Name a cause of a pansystolic murmur
Mitral regurgitation, tricuspid regurgitation
1) Name a cause of an early diastolic murmur
2) When will this type of murmur be called a Graham Steell murmur?
1) Aortic regurgitation, rarely pulmonary regurgitation and tricuspid stenosis
2) If the pulmonary regurgitation is secondary to pulmonary hypertension resulting from mitral stenosis
Name a cause of a mid diastolic murmur
Mitral stenosis (often caused by rheumatic fever), aortic regurgitation
Mitral regurgitation
1) What is the pathophysiology of mitral regurgitation and what does this lead to?
2) Name 2 causes of mitral regurgitation
3) What kind of murmur does it cause?
4) Name 1 thing that may be seen on a chest xray in a patient with mitral regurgitation
5) Name another test that may be used for the diagnosis of mitral regurgitation
1) Incompetent mitral valve allows blood to leak back through during contraction of the LV. This results in congestive cardiac failure due to the reduced ejection fraction and backlog of blood waiting to be pumped through the LV
2) Idiopathic weakening with age, IHD, rheumatic fever, IE, mitral valve prolapse, ruptured chordae tendineae, CT disorders i.e. Marfan
3) Pansystolic murmur that radiates to the axilla
4) Big left atrium and ventricle, pulmonary oedema
5) Echocardiogram, ECG,
Mitral stenosis
1) What is the pathophysiology of mitral stenosis?
2) Name a cause of mitral stenosis
3) Name a sign/way it might present
4) What kind of murmur does it cause
5) What imaging modality is diagnostic?
1) Narrow mitral valve which makes it difficult for the left atrium to push blood through the ventricle
2) Rheumatic fever, IE, congenital causes
3) Malar flush, AF, low volume pulse, loud S1
4) Mid diastolic
5) Echocardiogram
Aortic regurgitation
1) Name an acute cause
2) Name a chronic cause
3) Name a sign of aortic regurgitation
4) What kind of murmur does it cause?
5) How does it cause HF?
6) What imaging modality is diagnostic?
1) IE, ascending aortic dissection, chest trauma
2) Congenital, CT disorders, rheumatic fever, rheumatoid arthritis, SLE, spondyloarthropathies i.e. ankylosing spondylitis
3) Collapsing pulse, displaced apex
4) High pitched early diastolic murmur
5) Back pressure of blood waiting to get through the left side of the heart
6) Echocardiography
Aortic stenosis
1) Name a cause of aortic stenosis
2) What is the classic triad of aortic stenosis presentation?
3) Name a sign of aortic stenosis
4) What kind of murmur does it cause
5) What imaging modality is diagnostic?
6) If patient has no symptoms, how is it managed?
7) If patient is symptomatic, how is it managed?
8) Is this murmur heard loudest in inspiration or expiration?
9) What is the commonest cause of AS in u70s?
1) Senile calcification, rheumatic heart disease, congenital
2) Angina, syncope, HF
3) Narrow pulse pressure, slow rising pulse, exertional syncope
4) Ejection systolic, high pitched murmur that has a crescendo-decrescendo character. Radiates to carotids
5) Echocardiography
6) Observe patient
7) Valve replacement (px require catheter angiography prior to surgery to assess whether there’s underlying ischaemia)
8) Expiration
9) Bicuspid aortic valve
Aortic sclerosis
What murmur does aortic sclerosis cause?
Ejection systolic murmur
Tricuspid regurgitation
1) What happens/what is the pathophysiology?
2) Name a cause of tricuspid regurgitation
3) Name a symptom
4) What kind of murmur does it cause
1) Tricuspid valve doesn’t close properly and blood flows backwards into the right atrium
2) Functional i.e. RV dilatation due to pulmonary hypertension, rheumatic fever, IE, carcinoid syndrome, congenital
3) Fatigue, hepatic pain on exertion, ascites and oedema
4) Pansystolic murmur
Tricuspid stenosis
1) What happens/what is the pathophysiology?
2) Name a cause
3) Name a symptom
4) What kind of murmur does it cause?
1) Valve is narrowed which reduces the flow of blood from the right atrium to the right ventricle
2) Rheumatic fever, congenital, IE
3) Ascites, oedema, fatigue
4) Early diastolic murmur
Pulmonary regurgitation
1) What happens/what is the pathophysiology?
2) What can cause pulmonary regurgitation?
3) What kind of murmur does it cause
1) Blood leaks from the pulmonary arteries back into the right ventricle
2) Any cause of pulmonary hypertension
3) Decrescendo murmur in early diastole
