Murmurs and valvular pathology Flashcards
Aortic area
- 2nd ICS
- Right sternal border
Pulmonary area
- 2nd ICS
- Left sternal border
Erb’s point
- 3rd ICS
- Left sternal border
Tricuspid area
- 5th ICS
- Left sternal border
Mitral area
- 5th ICS space
- Midclavicular line
what valvular pathology cause left atrial hypertrophy and why
- Mitral stenosis
- Pushing against a stenosed valve is what cause hypertrophy
What valvular pathology causes LV hypertrophy
Aortic stenosis
what valular pathology would cause LA dilation and why ?
Mitral regurgitation : a leaky valve allows blood to flow back into a chamber causing it too thin and dilate
What valular pathology would cause LV dilatation
Aortic regurgitation
Describe the murmur heard in AS
- Ejection systolic
- High pitched
- Crescendo descendo
- Heard loudest in the aortic area
3 causes of AS
- Idiopathic age related calcification (most common) >65yrs
- Rheumatic disease
- Bicuspid aortic valve <65 ys
Radiation of murmur in AS
Carotids
3 other signs of AS
- Slow rising pulse
- Narrow pulse pressure
- Soft / absent S2
- S4
3 signs of severe AS
S : syncope (exertional)
A : angina
D : dyspnoea
Treatment of severe AS in pts high risk for open aortic valve replacement
Transcatheter aortic valve implantation
why can the apex be displaced in AS?
Due to LV hypertrophy caused by trying to push blood against a stenosed valve
what 3 Ix would you do in AS and why ?
- Echo - diagnostic
- ECG - LV hypertophy
- CXR - cardiomegaly
when is valvular replacement consider for AS
- Symptomatic
- Asymptomatic but with valvular gradient >40mmHg and with features such as LV systolic dysfunction
Murmur heard in aortic regurgitation and how is the intensity of the murmur increased
Early diastolic murmur
Handgrip manoeuvre
2 other features of aortic regurgitation
Collapsing pulse
wide pulse pressure
2 signs elicited in aortic regurgitation
- Quincke’s sign (nailbed pulsation).
- De Musset’s sign (head bobbing)
Further murmur heard in aortic regurgitation and why
Mid diastolic austin flint murmur if severe -> vibrating of mitral valve as blood flows back over it
Causes of AR due to valve disease and common acute presentation
- Rheumatic fever
- Calcific disease
- Connective tissue disease (RA/SLE)
Infective endocarditits
Murmur heard in mitral stenosis
Mid-late diastolic murmur
Best heard on inspiration
Other features heard in mitral stenosis
- Loud S1
- Opening snap : indicates valve leaflets are still mobile
Symptoms seen in mitral stenosis
SOB
Haemoptysis
Malar flush
Findings on CXR in MS
LA enlargement
Likely underlying valve disease if AF and mid-late diastolic murmur
Mitral stenosis
Most common cause of mitral stenosis
Rheumatic fever
Describe the murmur heard in Mr
Blowing pansystolic murmu
Heard best at the apex
Radiates to the axilla
what may be seen on ECG in MR
Broad P wave, indicative of atrial enlargement
What may be seen on CXR in MR
Cardiomegaly due to LA enlargment
Ejection systolic murmur
- AS
- Hypertrophic obstructive cardiomyopathy
- Pulmonary stenosis
- ASD
- TOF
Pansystolic murmur
- Mitral regurg
- Tricuspid regurg
- VSD
Early diastolic
Aortic regurg (high pitched and blowing)
Mid - late diastolic
Mitral stenosis (rumbling)
Continuous machinery like
PDA
Ejection systolic louder on expiration
Aortic stenosis or hypertrophic obstructive cardiomyopathy
Ejection systolic louder on inspiration
Pulmonary stenosis
ASD
Pansystolic, louder on inspiration
Tricuspid regurgitation
