Valvular heart disease Flashcards
What causes the first heart sound (S1)?
The closing of the atrioventricular valves (mitral and tricuspid) at the start of systole.
What causes the second heart sound (S2)?
The closing of the semilunar valves (aortic and pulmonary) at the end of systole.
What is a third heart sound (S3) and when is it heard?
S3 is caused by rapid ventricular filling and is heard around 0.1 seconds after S2. It can be normal in young people but may indicate heart failure in older adults.
What is a fourth heart sound (S4) and when is it heard?
S4 is heard before S1 and indicates a stiff or hypertrophic ventricle, often caused by turbulent flow from the atria contracting against a non-compliant ventricle.
How do you best listen for low-pitched sounds (e.g., murmurs)?
Use the bell of the stethoscope.
Where do you auscultate for heart murmurs?
Pulmonary area: 2nd intercostal space, left sternal border.
Aortic area: 2nd intercostal space, right sternal border.
Tricuspid area: 5th intercostal space, left sternal border.
Mitral area: 5th intercostal space, mid-clavicular line (apex area).
What mnemonic is used to assess heart murmurs?
‘SCRIPT’
S: Site
C: Character
R: Radiation
I: Intensity
P: Pitch
T: Timing
What does a Grade I murmur mean?
A Grade I murmur is difficult to hear.
What is the murmur grading scale?
Grade I: Difficult to hear.
Grade II: Quiet.
Grade III: Easy to hear.
Grade IV: Easy to hear with a palpable thrill.
Grade V: Audible with stethoscope barely touching the chest.
Grade VI: Audible with stethoscope off the chest.
What does aortic stenosis cause in terms of heart sounds?
Aortic stenosis causes a high-pitched, ejection-systolic murmur with a crescendo-decrescendo character and radiates to the carotids.
What are common signs of aortic stenosis?
Thrill in the aortic area.
Slow rising pulse.
Narrow pulse pressure.
Exertional syncope.
What are common causes of aortic stenosis?
Idiopathic age-related calcification.
Bicuspid aortic valve.
Rheumatic heart disease.
What murmur is heard in aortic regurgitation?
Aortic regurgitation causes an early diastolic, soft murmur, and may have an Austin-Flint murmur (rumbling at the apex).
What are common signs of aortic regurgitation?
Collapsing pulse.
Wide pulse pressure.
Heart failure and pulmonary oedema.
What causes mitral stenosis?
Mitral stenosis is most commonly caused by rheumatic heart disease or infective endocarditis.
What is a classic murmur for mitral stenosis?
A low-pitched, mid-diastolic rumbling murmur with a loud S1 and an opening snap after S2.
What are signs of mitral stenosis?
Tapping apex beat.
Malar flush.
Atrial fibrillation.
What is heard in mitral regurgitation?
A pan-systolic, high-pitched ‘whistling’ murmur that radiates to the left axilla.
What are the causes of mitral regurgitation?
Idiopathic weakening of the valve.
Ischaemic heart disease.
Infective endocarditis.
Rheumatic heart disease.
Connective tissue disorders (e.g., Ehlers-Danlos, Marfan syndrome).
What is the murmur heard in tricuspid regurgitation?
A pan-systolic murmur.
What are signs of tricuspid regurgitation?
Raised JVP with giant C-V waves.
Pulsatile liver.
Peripheral oedema.
Ascites.
What causes pulmonary stenosis?
Pulmonary stenosis is usually congenital and associated with conditions like Noonan syndrome or Tetralogy of Fallot.
What is the murmur heard in pulmonary stenosis?
An ejection systolic murmur, loudest in the pulmonary area, with deep inspiration. There is a widely split second heart sound.
What is a common cause of pulmonary stenosis?
Pulmonary stenosis is commonly congenital, such as in Noonan syndrome and Tetralogy of Fallot.
