Valvular Heart Disease Flashcards
Describing murmurs?
- Timing
- Location
- Grade
- Character
- Shape
- Pitch
- Radiation
Timing of murmurs?
A murmur is either:
1. systolic
2. diastolic
3. continuous throughout systole and diastole.
- Remember that systole occurs between the S1 and S2 heart sounds, whereas diastole occurs between S2 and S1
The 4 main listening posts on the chest for determing the location of murmurs?
- A = aortic valve post (right upper sternal border)
- P = pulmonic valve post (left upper sternal border)
- T = tricuspid valve post (left lower sternal border 4th ICS)
- M = mitral valve post (apex)
- E = ‘Erb’s point’ (left sternal border 3rd ICS)
Aortic murmurs?
sytolic murmurs
1. aortic stenosis
2. aortic valve sclerosis
3. flow murmur
Pulmonary valve murmur?
systolic murmur
1. flow murmur
2. pulmonic stenosis
Tricuspid valve murmurs?
systolic
1. tricuspid regurgitation
2. ventricular septal defect
diastolic
1. tricuspid stenosis
2. atrial septal defect
Mitral valve murmurs?
systolic
1. mitral regurgitation
diastolic
1. mitral stenosis
Erbs point murmurs?
diastolic
1. aortic regurgitation
2. pulmonic regurgitation
systolic
1. hypertrophic obstructive cardiomyopathy (HOCM)
Where to hear a PDA murmur?
left 1st rib
Grading systolic murmurs?
Grade 1
very faint , may only be heart by expert and not heard in all positions
Grade 2
soft and heard in all positions
Grade 3
moderately loud but no thrill
Grade 4
very loud with associated thrill
Grade 5
loud with the edge of stethoscope tilted against the chest
Grade 6
very loud and can be heard with the stethoscope just off the chest wall
Diastolic murmurs?
Grade 1
Very soft and can only be heard by exert or very quite room
Grade 2
Soft
Grade 3
Moderately loud
Grade 4
Loud or associated with a thrill
Character of the murmur?
Systolic murmurs can be classified as either
1. midsystolic (systolic ejection murmurs, or SEM),
- A midsystolic murmur begins just after the S1 heart sound and terminates just before the P2 heart sound: thus, S1 and S2 will be distinctly audible
2. holosystolic (pansystolic)
- begins with or immediately after the S1 heart sound and extends up to the S2
3. late systolic.
4. Mid-late systolic murmur
- begins significantly after S1 and may or may not extend up to the S2.
Shape of the murmur?
- The shape of a murmur describes the change of intensity throughout the cardiac cycle.
- Murmurs are either crescendo, decrescendo, crescendo-decrescendo or uniform
Pitch of a murmur?
A murmur will be high pitched if there is a large pressure gradient across the pathologic lesion or
- low: if the pressure gradient is low
- high: if the pressure gradient is high
Low pitched murmurs?
murmur of mitral stenosis
- is low pitched because there is a lower pressure gradient between the left atrium and the left ventricle during diastole.
High pitched murmur?
murmur of aortic stenosis
- is high pitched because there is usually a large pressure gradient between the left ventricle and the aorta.
How to listen to pitch of the murmurs?
Remember high-pitched sounds are heard with the diaphragm of the stethoscope, whereas low-pitched sounds are heard with the bell.
Radiation of murmurs?
While murmurs are usually most intense at one specific listening post, they often radiate to other listening posts or areas of the body.
1. murmur of aortic stenosis frequently radiates to the carotid arteries
2. murmur of mitral regurgitation radiates to the left axillary region
Causes of mitral stenosis?
- Acquired is often from rheumatic heart disease
- Congenital causes are very rare
Clinical presentation of mitral stenosis in history?
- SOB
- orthopnea
- PND
- hemoptysis
- abdominal swelling or limb swelling