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Cardiology > Murmurs/Valvular heart disease > Flashcards

Murmurs/Valvular heart disease Flashcards

1
Q

How can you amplify a MR murmur upon examination?

A

Ask patient to hold breath

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2
Q

What does MR sound like?

A

high-pitched, “blowing” holosystolic murmur best heard at the apex. Can sound like ‘tss’

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3
Q

What is the surface anatomy for aortic area when auscultating?

A

2nd intercostal space, right sternal boarder

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4
Q

Surface anatomy for pulmonary area?

A

2nd intercostal space, left sternal boarder

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5
Q

Surface anatomy for tricuspid area?

A

5th intercostal space, left sternal boarder

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6
Q

Surface anatomy for mitral area?

A

5th intercostal space, midclavicular line

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7
Q

Which manoeuvres can be done to amplify two murmurs?

A

MS- roll to left hand side

AR- sit up and lean forward, breathe out and hold

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8
Q

Which acronym can be used to describe features of a murmur?

A

SCRIPT
Site- where is the murmur loudest?
Character- soft? blowing? crescendo? decrescendo?
Radiation- carotids? (AS), axilla? (MR)
Intensity- grade of murmur?
Pitch- high? low and grumbling? indicated velocity
Timing- systolic? diastolic?

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9
Q

What is the process for grading murmurs?

A

Grade 1- difficult to hear
Grade 2- quiet
Grade 3- easy to hear
Grade 4- easy to hear with palpable thrill
Grade 5- hear with stethoscope barely touching chest
Grade 6- can hear murmur with stethoscope off the chest

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10
Q

What are two causes of mitral stenosis?

A

rheumatic heart disease and infective endocarditis

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11
Q

How to describe mitral stenosis murmur?

A

mid diastolic, low pitched, rumbling murmur. Loud S1

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12
Q

Which sign of mitral stenosis can be seen in the face?

A

malar flush (back pressure of blood in pulmonary system, rise in CO2 and vasodilation)

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13
Q

How can mitral regurgitation murmur be described?

A

pan-systolic murmur (heard throughout systolic period), high pitched whistling

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14
Q

What are the causes of MR?

A

Idiopathic weakening with age, ischaemic heart disease, infective endocarditis, rheumatic heart disease, marfan’s syndrome

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15
Q

How can aortic stenosis murmur be described?

A

ejection systolic murmur, high pitched, crescendo-decresceno

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16
Q

Where can AS murmur radiate to?

A

carotid area

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17
Q

What is the pulse pressure in AS?

A

narrow pulse pressure

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18
Q

What are the causes of AS?

A

rheumatic heart disease and aging

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19
Q

How can aortic regurgitation be described?

A

soft, early diastolic, very subtle murmur!!! Easily missed

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20
Q

Which clinical sign is associated with aortic regurgitation?

A

collapsing pulse= corrigan’s pulse = rapidly appears and then disappears

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21
Q

What is an austin flint murmur?

A

results from aortic regurgitation, heard at apex, early diastolic rumbling

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22
Q

Causes of AR?

A

age related, marfan’s syndrome (connective tissue disorder, causes both aortic and mitral regurg)

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23
Q

A patient is fluid overloaded. You auscultate heart valves and amazingly determine a mitral regurgitation murmur. You wonder whether to do an echo. How should you proceed?

A

Fluid overload can mimic MR, therefore do not echo until fluid overload has been resolved. Volume overload often occurs in response to mitral or aortic regurgitation, wherein a significant portion of blood ejected by the left ventricle in systole is not delivered to the systemic circulation, but instead is either returned to the left ventricle or delivered to the left atrium

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24
Q

What are the surgical/radiological intervention for murmurs?

A

Prosthetic valve (shorter lifespan that metallic valves), metallic valves (lifelong anticoagulation with warfarin), and TAVI

25
Q

Which valve is TAVI only performed on?

A

aortic valve= transcatheter aortic valve implantation

26
Q

How to document heart sounds/murmurs?

A

HS I + II + murmur *
AS- crescendo-decrescendo/ejection systolic
MR- pansystolic

27
Q

How should your exam differ for thrills and heaves? Clue- hand

A

Thrills- use two fingers

Heave- use whole palm of hand

28
Q

How to distinguish between AS radiation and carotid bruit?

A

Bruit will only be heard in one carotid whereas AS will radiate to both

29
Q

What is the criteria score for infective endocarditis?

A

Duke’s criteria

30
Q

List the triad of syx in AS

A

angina, dyspnoea, syncope

31
Q

Which type of heart failure arises in AS?

A

LVF

32
Q

Describe four symptoms of AS

A

angina, dyspnoea, syncope
orthopnoea, frothy sputum
arrhythmias

33
Q

List three clinical signs of AS

A 
aortic thrill
forceful apex beat
Systolic ejection murmur
narrow pulse pressure
S4
34
Q

List three differentials for AS

A

Coronary artery disease
MR
Aortic sclerosis

35
Q

What is the medical management for AS?

A

optimise risk factors- statins, antihypertensives, DM

treat associated disease- HF, angina

36
Q

What is the surgical management of AS?

A

Mechanical or prosthetic valve replacement

37
Q

What is a pro and con of mechanical heart valves?

A

Mechanical valves last longer but need

anticoagulation: young pts.

38
Q

Pro and con of prosthetic heart valves?

A 
Bioprosthetic don’t require anticoagulation but 
fail sooner (10-15yrs)
39
Q

If heart valve replacement is contraindicated, what are the other options?

A

TAVI- transcatheter aortic valve implantation

Balloon valvuloplasty

40
Q

List two causes of AR?

A

IE, rheumatic heart disease, Marfan’s

41
Q

Describe three clinical signs of AR you would find on examination?

A

collapsing pulse
Wide pulse pressure
Displaced apex beat
Ejection diastolic murmur

42
Q

What is corrigan’s sign?

A

pulse that is bounding and forceful, rapidly increasing and subsequently collapsing- AR

43
Q

List two causes of mitral stenosis

A

Rheumatic fever
Prosthetic valve
Congenital

44
Q

List three clinical signs of mitral stenosis

A

malar flush
Mid-diastolic murmur
Raised JVP
Left parasternal heave

45
Q

Why does malar flush arise in mitral stenosis?

A

CO2 retention, causing vasodilation of arterioles in cheeks

46
Q

Name one complication of MS

A

pulmonary HTN

47
Q

Three causes of MR?

A 
rheumatic fever
Marfan's/connective tissue disorder
post-MI
Calcification 
Mitral valve prolapse
48
Q

Two symptoms of all valvular abnormalities?

A

Dyspnoea, fatigue

49
Q

Three clinical signs of MR?

A

Displaced apex beat
Pansystolic murmur
AF
Right ventricular heave

50
Q

Differential for MR?

A

AS, tricuspid regurg, ventricular septal defect

51
Q

Are semilunar valves more complicated than atrioventricular valves?

A

no they are much more simple, they are pressure controlled

52
Q

What are the components of the atrioventricular valves?

A

chordae tendinae and papillary muscles (and valve leaflets)

53
Q

What is the subvalvular apparatus and what is its function?

A

combination of chordae tendinae and papillary muscles. Prevents valve prolapse into the atria when they close

54
Q

What are symptoms of aortic stenosis?

A

shortness of breath, presyncope, syncope, chest pain, reduced exercise capacity

55
Q

What are the signs of aortic stenosis?

A

ejection systolic murmur, quiet second heart sound, narrowed pulse pressure, heaving apex beat (LVH), signs of heart failure

56
Q

De Mussett’s (head nodding), Corrigan’s carotid pulsation), and Quinke (nail bed pulsation), are signs of which disease?

A

Aortic regurg

57
Q

Name a structural valve disorder of the aortic valve

A

bicuspid aortic valve- valve is normally tri-leaflet but becomes bicuspid in appearance

58
Q

What are the standard assessments for valvular disease?

A

hx, examination, blood pressure, ECG, echo, CT, MRI

Cardiology (14 decks)

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