Topic 27 - The endocardial and extracardial murmurs. Characteristics of the heart murmurs.

Question 1

What is a heart murmur?

Answer 1

a sound made by turbulent blood flow within the heart

Question 2

What is endocardial murmurs?

Answer 2

Caused by turbulence.
The murmur originate within the heart, associated with the blood flow

Question 3

What is extracardiac murmurs?

Answer 3

Murmur that originates outside the heart.

Due to inflammation

Question 4

What can be the cause of endocardial murmurs?

Answer 4

Either morphological or functional

Morphological = valve deformities, septal or vessel malformations

Functional = innocent murmurs, anaemia

Question 5

What are the parameters to classify the endocardial heart murmurs?

Answer 5

Localization
Intensity
Relation to the phase of the cardiac cycle
Frequency (pitch)
Character (quality, shape)
Conduction

Question 6

How can we localize the endocardial murmurs?

Answer 6

1. Points of maximal intensity
2. Determination of intercostal spaces in medium and large size animals
3. Heart base and apex assignment

Question 7

Localization of the different heart valves, the puncta maxima:

IMPORTANT!!

Answer 7

Pulmonary valve: Left side, ICS3
Aortic valve: Left side, ICS4
Mitral valve: Left side, ICS 5
Tricuspid valve: Right side, ICS 4

Question 8

Name the different phases of the cardiac cycle:

Answer 8

Systole and diastole

Question 9

How can we differentiate the frequency/pitch?

Answer 9

Low, medium, high
Pitch: blowing, whistling, crackling, rough, musical murmurs

Question 10

Causes for extracardial murmurs:

Answer 10

Due to inflammation

Question 11

Examples that can cause extracardiac murmurs:

Answer 11

1. Pericarditis
2. Vascular abnormalities
3. Thoracic inflammation

Question 12

What is pericarditis and why does it cause a murmur?

Answer 12

Inflammation of pericardium

The pericardium layer is rubbing against the heart, causing a murmur

Question 13

What is vascular abnormalities and why does it cause a murmur?

Answer 13

Inflammation or abnormalities of the blood vessels

Affecting aorta or pulmonary artery, causing a murmur

Question 14

What is thoracic inflammation and why does it cause a murmur?

Answer 14

Lung inflammation or fluid accumulation

The fluid can affect the heart sound, causing a heart murmur

Question 15

Which valve can we find at the base of the heart?

Answer 15

Semilunar valves

Found between heart and aorta, and also between the heart and pulmonary artery

Question 16

How can we grade the different heart murmurs?

Answer 16

By number:
1/6
2/6
3/6
4/6
5/6
6/6

Question 17

Describe the grade 1/6 heart murmur:

Answer 17

Very soft murmur, heard only after a few seconds in a quiet room

Question 18

Describe the grade 2/6 heart murmur:

Answer 18

Soft murmur but easily heard directly upon auscultation

Question 19

Describe the grade 3/6 heart murmur:

Answer 19

Moderate-intensity murmur with good audibility.

Question 20

Describe the grade 4/6 heart murmur:

Answer 20

Loud murmur, very good audibility, but without precordial thrill

Question 21

Describe the grade 5/6 heart murmur:

Answer 21

Very loud murmur with precordial thrill

Question 22

Describe the grade 6/6 heart murmur:

Answer 22

Loudest murmur, even audible with stethoscope lifted from the chest wall