Murmurs & Pulses Flashcards
What are the sounds S1 and S2 representing?
S1 represents mitral and tricuspid valve closing
S2 represents aortic and pulmonary valve closing
Pathophysiology:
Regurgitation
Stenosis
What are left heart murmurs and right heart murmurs?
Closing problem - regurg
Opening problem - stenosis
Left heart murmurs are systolic murmurs
Right heart murmurs are diastolic murmurs
Systolic murmurs [5]
Aortic stenosis Pulmonary stenosis Mitral regurgitation Tricuspid regurgitation MVP
Diastolic murmurs [4]
Aortic regurgitation
Pulmonary regurgitation
Mitral stenosis
Tricuspid stenosis
Extra heart sounds
Systolic clicks
Opening snap
S3
S4
Aortic stenosis Murmur Explanation Character Radiation
"Systolic ejection murmur" Ejection click When turbulent blood flows through stenotic aortic valve Crescendo-decrescendo murmur Radiation to carotid artery in the neck
Pulmonary stenosis
Murmur character [3]
Explanation
Radiation
“Systolic ejection murmur”
Ejection click
Crescendo-decrescendo murmur
When turbulent blood flows through stenotic pulmonary valve
Location: pulmonary area
Radiation: none
Mitral regurgitation
Murmur character
Explanation [2]
Radiation
“Holosystolic or pansystolic murmur”
Mitral valve doesn’t close and some flow to atrium occurs throughout the cycle
So murmur intensity doesn’t change throughout cycle
Radiation: axilla
Tricuspid regurgitation
Murmur character
Radiation
Location
Same as MR
Pansystolic murmur
Location: tricuspid area
Mitral valve prolapse Murmur character [2] Cause Radiation Location
Late systolic murmur
Non-ejection click or mid-late systolic click
Cause: loose chord tendinae
Associated with MR so after non-ejection click, its an MR murmur
Location: apex
Aortic regurgitation
Murmur character [2]
Location
Explanation [2]
“Early diastolic murmur”
Descrescendo murmur
Location: left sternal border
As ventricle fills up with blood, turbulent blood flow becomes less turbulent
Pulmonary regurgitation
Murmur character
Location
Same as AR
Location: upper left sternal border
Mitral stenosis
Character [2]
Explanation [3]
Opening snap then mid-diastolic rumble with sloping appearance
- Rapid filling occurs at the beginning of diastole (after s2) as this is when the pressure difference is highest. This is the most intense part of the murmur
- As pressures equalise the intensity of the murmur reaches lowest point
- Atrium contracts to push leftover blood into ventricle (pre-systolic accentuation) causing slight increase in intensity towards S1
Tricuspid stenosis
Murmur character
Location
Same as MS
Location: tricuspid area
In which conditions are the following systolic clicks heard?
Ejection click
Non-ejection click
Opening snap
Ejection click: Aortic stenosis
Non-ejection click: Mitral valve prolapse
Opening snap: mitral stenosis
S3 and S4 heart sounds
Where are they typically heard?
S3 and S4 are not murmurs
Location: mitral, lying in decubitus position
S3
- is also known as…
- Diastolic or systolic?
- Explanation [3]
Ventricular gallop
Early diastole, occuring just after S2
1. Volume overload as in CHF
2. Rapid filling phase, ventricles fill up quicker
3. Chordae tendinae tense producing S3 sound
S4
- Explanation [3]
- When does it occur in the cycle?
Pressure overload as in high blood pressure
LVH strain, concentric hypertrophy
Heart has to contract against increased pressure
Occurs end-diastolic
Pulsus paradoxes [3]
- greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration
→ faint or absent pulse in inspiration - severe asthma, cardiac tamponade
Slow-rising/plateau pulse - what’s the clinical significance
Aortic stenosis
• in this condition the rate of ejection of blood into theaortais decreased so that the duration of the ejection is prolonged. The amplitude of thepulseis diminished as a consequence.
Collapsing pulse
Clinical significance [3]
describes a pulse that is bounding and forceful, rapidly increasing and subsequently collapsing (sound of a hammer hitting water)
- aortic regurgitation
- patent ductus arteriosus
- hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)
Pulsus alternans [2]
regular alternation of the force of the arterial pulse
severe LVF
Bisferiens pulse: description and clinical significance [2]
‘double pulse’ - two systolic peaks
mixed aortic valve disease
Jerky pulse is indicative of…
hypertrophic obstructive cardiomyopathy
*HOCM may occasionally be associated with a bisferiens pulse
Eponymous signs of aortic regurgitation [5]
Corrigan's - exaggerated carotid pulse Quinke's - nailbed pulsation De Musset's - head nodding Duroziez's - diastolic femoral murmur Traube's - 'pistol shot' femorals
