30. Heart Murmurs Flashcards Preview

YR3: MM FC Ed. > 30. Heart Murmurs > Flashcards

Flashcards in 30. Heart Murmurs Deck (39)
Loading flashcards...
1

What sound is S1? What causes this? When does this occur?

LUB
closing of mitral + tricuspid valves
At start of systolic contraction of ventricles

2

What sound is S2? What causes this? When does this occur?

DUB
Closing of aortic + pulmonary valves
After systolic contraction is complete (to prevent backflow)

3

What sound is S3? What causes this? When does this occur?

Lub(S1)- De(S2)-Dub(S3)
Rapid ventricular filling causing chordae tendonae to pull to full length
Subtle
.1s after 2nd heart sound

4

When is S3 normal? When is S3 pathological?

Normal: 15-40 yr olds
Pathological: older patients- can indicate HF as ventricles + chordae are stiff + weak

5

What sound is S4? What causes this? When does this occur?

Le (S4)- Lub (S1)- Dub (S2)
Turbulent flow from atria contracting against a ventricle that is non compliant.
Heard directly before S1

6

Is S4 normal? What does the presence of S4 suggest?

ALWAYS ABNORMAL
Indicates stiff or hypertrophic ventricle

7

List the 4 sites to auscultate for murmurs

Aortic valve 2nd ICS right sternal border
Pulmonary valve 2nd ICS left sternal border
Tricuspid valve 5th ICS left sternal border
Mitral valve 5th ICS MCL

8

What is ERBs point and why auscultate here?

Best place to listen to heart sounds (S1-4)
3rd ICS left sternal border.

9

How would you position a patient to listen for mitral stenosis?

Roll patient onto left hand side

10

How would you position a patient to listen for aortic regurgitation?

Sit patient up
Lean them forward
Ask them to take deep breath out + hold

11

What mnemonic can be used to assess heart murmurs?

SCRIPT
Site: Where is it loudest?
Character: Soft? Blowing? Crescendo? Decrescendo?
Radiation: can you hear murmur going to carotids? (AS) or left axilla? (MR)
Intensity: Grade?
Pitch: high pitched? low + grumbling? (velocity)
Timing: Systolic? Diastolic?

12

How do you grade a murmur?

1 = difficult to hear
2 = quiet
3 = Easy to hear
4 = Easy to hear with palpable thrill
5 = Hear with stethoscope barely touching chest
6 = Hear with stethoscope off chest, just holding nearby

13

Describe what commonly causes a heart to hypertrophy

When heart muscle is pushing against a stenotic valve, it has to work a lot harder to get blood through that valve

14

Describe the pathological effect of mitral stenosis on the heart

LA has to work really hard to push blood through the mitral valve, thus results in LA hypertrophy

15

Describe the pathological effect of aortic stenosis on the heart

LV has to work really hard to push blood through the aortic valve, thus results in LV hypertrophy

16

Describe what commonly causes heart dilatation

A leaky valve, allowing blood to flow back into the chamber stretches the muscle

17

Describe the pathological effect of mitral regurgitation on the heart

Blood flows back through the mitral valve into the LA, thus results in LA dilatation

18

Describe the pathological effect of aortic regurgitation on the heart

Blood flows back through the aortic valve into the LV, thus results in LV dilatation

19

Give 2 causes of mitral stenosis

Rheumatic heart disease
Infective endocarditis

20

Describe the murmur heard in mitral stenosis

Mid diastolic
Low pitched
Rumbling
Due to low velocity of blood flow

21

What sound is heard in mitral stenosis?

LUB! Dub Durrrrrr
Loud S1 as thick valves require large systolic force to shut

22

What 2 things may be found on examination in mitral stenosis?

Malar flush
Palpable tapping apex beat

23

What rhythm is mitral stenosis associated with?

Atrial fibrilation

24

Give 5 causes of mitral regurgitation

Idiopathic weakening of valve with age
IHD
Infective endocarditis
Rheumatic heart disease
Connective tissue disorders e.g. Marfaans

25

Describe the murmur heard in mitral regurgitation

Pan-systolic
High pitch whistling (High velocity through leaky valve)
Radiates to left axilla

26

What sound is heard in mitral regurgitation?

BURRRR (throughout systole)

27

What is mitral regurgitation associated with?

Congestive heart failure- leaking valve causes reduced ejection fraction, causes backlog of blood waiting to pass through left side of heart ∴ may hear S3 if HF present

28

Give 3 causes of aortic stenosis

Idiopathic age related calcification
Congenital bicuspid valve
Rheumatic heart disease

29

Describe the murmur heard in aortic stenosis

Ejection systolic- occurs while blood is being ejected from LV
High pitched
Crescendo-Decresendo due to speed of blood flow at different points of systolic contraction
Radiates to carotids as turbulence continues up to the neck

30

What sound is heard in aortic stenosis?

BURRRR-DUB