Cardiac Murmurs Flashcards
Normal Heart Sounds Mitral Stenosis
Mitral Stenosis Cause
rheumatic fever
Mitral Stenosis on examination
Look: mitral facies, central cyanosis (pulmonary hypertension)
Feel: low volume irregular pulse ?
Listen: low pitched, diastolic murmur, best heard at the apex. Loud S1. Sometimes a third heart sound which is the valve snapping open after S2.
Normal Heart Sounds
S1: Tricuspid and Bicuspid snap shut. Pulmonic and aortic open.
S2: Pulmonic and aortic snap shut. T and B open.
Systole: Between S1 and S2
Diastole: Between S2 and S1.
Mitral Stenosis Investigations and Findings
ECG: atrial fibrillation OR in sinus rythm, P Mitral. RV hypertrophy (due to pulmonary hypertension) and therefore progressive right axis deviation.
Echocardiography: thickened and calcification of mitral leaflets. Mitral opening will coincide with snap sound. Pulmonary valve may be flat in PH.
Catheterisation: assess the left atrial pressure
Mitral Stenosis treatment: medical and surgical
Medical: digoxin (for AF), diuretics (reduce preload and pulmonary venous congestion)
Surgical: cardioversion (for AF), closed mitral valvotomy, open mitral valvotomy, mitral valve replacement
Aortic Stenosis is a … murmur which radiates to..
- ejection systolic
- carotid
Aortic stenosis murmur features
Soft/absent S2
S4 sound
S4 S1woooosh softS2
S3 and S4 are heard best at the…
Cardiac apex
S3 heart sound is heard…
Straight after S2
S4 heard sound is heart…
Directly before S1
Aortic stenosis cause
Calcification of the valve >65
Bicuspid aortic valve <65
Aortic stenosis clinical signs
Narrow pulse pressure
Slow rising pulse
Thrill
Left Ventricular hypertrophy or failure
Management of aortic stenosis
If asymptomatic
If symptomatic
If asymptomatic but symptoms of dysfunction
if asymptomatic: observation only
If symptomatic: valve replacement
If asymptomatic but symptoms of dysfunction: consider surgery
How to hear aortic regurgitation
sitting forward, upright, and full expiration
