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Summer 21 SBA > heart murmurs > Flashcards

heart murmurs Flashcards

1
Q

What does aortic stenosis refer to?

A

tightening of the aortic valve at the origin of the aorta

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2
Q

What is aortic stenosis associated with?

A

An ejection systolic murmur heard loudest over the aortic valve

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3
Q

what is the aortic stenosis murmur described as having?

A

Crescendo-decrescendo quality

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4
Q

where does the aortic stenosis murmur commonly radiate to?

A

Carotid arteries

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5
Q

What are the causes of aortic stenosis?

A

Calcification of the aortic valves

Congenital abnormality of the aortic valve

Rheumatic heart disease

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6
Q

What can be done to accentuate an aortic stenosis murmur?

A

Ask patient to lean forward, and breath out, hold breath - this is when this murmur can be heard loudest

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7
Q

What are some of the other clinical features of aortic stenosis?

A

Slow rising pulse with narrow pulse pressure

Non-displaced, heaving apex beat (if present indicates left ventricular hypertrophy)

Reduced or absent S2 (a sign of moderate-severe aortic stenosis)

Reverse splitting of S2: aortic valve closes after pulmonary valve (due to the longer time required for blood to exit the left ventricle)

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8
Q

When does mitral regurgitation occur?

A

When there is backflow of blood from the left ventricle into the left atria during ventricular systole.

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9
Q

What is mitral regurgitation associated with?

A

a pansystolic murmur heard loudest over the mitral area

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10
Q

Where does mitral regurgitation murmur radiate too?

A

axilla

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11
Q

What are the causes of mitral regurgitation?

A

Infective endocarditis

Acute myocardial infarction with rupture of papillary muscles

Rheumatic heart disease

Congenital defects of the mitral valve

Cardiomyopathy

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12
Q

When is mitral regurgitation heard loudest

A

on expiration in the left lateral decubitus position

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13
Q

What are some other clinical features of mitral regurgitation?

A

Displaced, hyperdynamic apex beat

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14
Q

When does aortic regurgitation occur?

A

when there is a backflow of blood from the aorta into the left ventricle during ventricular diastole

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15
Q

What is aortic regurgitation associated with?

A

early diastolic murmur heard loudest at the left sternal edge

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16
Q

What are diseases affecting the valve that can cause AR?

A

Congenital bicuspid aortic valve

Rheumatic heart disease

Infective endocarditis

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17
Q

What are causes of aortic root dilatation that results in AR?

A

Aortic dissection: can result in acute aortic regurgitation

Connective tissue diseases (e.g. Marfan’s syndrome)

Aortitis

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18
Q

What is the Austin flint murmur?

A

a low pitched rumbling mid-diastolic murmur heard best at the apex. This is caused by the regurgitated blood through the aortic valve mixing with blood from the left atrium, during atrial contraction.

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19
Q

What is the Austin flint murmur a sign of?

A

Severe aortic regurgitation

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20
Q

What are some other clinical features of AR?

A

collapsing pulse

displaced hyperdynamic apex beat

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21
Q

What does mitral stenosis involve and what does this cause?

A

narrowing of the mitral valve, which results in decreased filling of the left ventricle during systole and increased left atrial pressure

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22
Q

What is mitral stenosis associated with?

A

a low-pitched, rumbling, mid-diastolic murmur heard loudest over the apex

23
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease

24
Q

What are other causes of mitral stenosis?

A

Congenital

Left atrial myxoma

Connective tissue disorders

Mucopolysaccharidosis

25
Q

What are typical clinical features of mitral stenosis?

A

Low-pitched, rumbling mid-diastolic murmur with an opening click (click heard in mid-diastole when the mitral valve opens)

Murmur is heard loudest over the apex

Loudest in left lateral decubitus position on expiration

26
Q

What are other clinical features of mitral stenosis?

A

A low-volume pulse which may be irregularly, irregular

Loud first heart sound with tapping apex beat

A malar flush (plum-red discolouration of the cheeks)

27
Q

When does a mitral valve prolapse occur?

A

mitral valve leaflets prolapse into the left atrium during systole

28
Q

What is mitral valve prolapse associated with?

A

a combination of a mid-systolic click and mid to late-systolic murmur

29
Q

What are the typical features of mitral valve prolapse murmur?

A

Mid-systolic click (prolapse of the mitral valve into the left atrium)

Followed by a mid or late-systolic murmur

Heard loudest at the apex

Loudest in expiration

30
Q

When does a tricuspid regurgitation murmur occur?

A

when there is the backflow of blood from the right ventricle into the right atrium during ventricular systole

31
Q

What does tricuspid regurgitation cause?

A

an increase in right atrial pressure and elevated venous pressures

32
Q

What is tricuspid regurgitation associated with?

A

a pansystolic murmur heard loudest over the tricuspid region

33
Q

What are causes tricuspid regurgitation?

A

Right ventricular dilatation (e.g. secondary to pulmonary stenosis or pulmonary hypertension)

Rheumatic fever

Infective endocarditis (intravenous drug users are at high risk of endocarditis affecting the tricuspid valve)

Carcinoid syndrome

Congenital (e.g. atrial septal defect, Ebstein anomaly)

34
Q

What is the Ebstein anomaly?

A

abnormal attachment of tricuspid valve leaflets which causes the tricuspid valve to displace downwards into the right ventricle.

35
Q

What are typical clinical features of a tricuspid regurgitation murmur?

A

Pansystolic murmur
Heard loudest over the tricuspid region
Loudest during inspiration

36
Q

What are other clinical features of tricuspid regurgitation?

A

Large ‘v-waves’ visible in the jugular veins: caused by the right atrial filling of blood against a closed tricuspid valve

Visible/palpable hepatic pulsations

Signs of right-sided heart failure: right ventricular heave, peripheral oedema, hepatomegaly, ascites

37
Q

What does pulmonary stenosis refer too?

A

the narrowing of the pulmonary valve

38
Q

What are causes of pulmonary stenosis?

A

Congenital: Turner’s, Noonan’s and Williams syndromes. Tetralogy of Fallot (pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect and an overriding aorta).

Rheumatic fever

Carcinoid syndrome

39
Q

What are typical features of a pulmonary stenosis murmur?

A

Ejection systolic murmur heard loudest over pulmonary area

Loudest during inspiration

Radiates to left shoulder/left infraclavicular region

In severe pulmonary stenosis, the murmur is longer and may obscure the sound of A2

40
Q

What are other clinical features of pulmonary stenosis?

A

Prominent ‘a waves’ in the jugular veins

Widely split S2: blood from the ventricles takes longer to pass through a narrow pulmonary valve, so pulmonary valve closure occurs much later than aortic valve closure

P2 may be soft and inaudible

Right ventricular dilatation can lead to a right ventricular heave, tricuspid regurgitation and peripheral signs of right-sided heart failure

41
Q

When does pulmonary regurgitation occur?

A

backflow of blood from the pulmonary artery into the right ventricle during ventricular diastole

42
Q

What are causes of pulmonary regurgitation?

A

Pulmonary hypertension

Infective endocarditis

Congenital valvular heart disease

43
Q

T/F - Pulmonary regurgitations are usually asymptomatic?

A

True

44
Q

What are typical features of a pulmonary regurgitation murmur?

A

Early decrescendo murmur heard loudest over the left sternal edge

Loudest during inspiration

Usually due to pulmonary hypertension: known as a Graham Steell murmur when associated with mitral stenosis

45
Q

What does tricuspid stenosis refer to?

A

narrowing of the tricuspid valve

46
Q

What is tricuspid stenosis associated with?

A

a soft diastolic murmur heard loudest at 3rd – 4th intercostal space at the left sternal edge

47
Q

What are causes of tricuspid stenosis?

A

heumatic fever (most common)

Congenital disease

Infective endocarditis

48
Q

What are typical clinical features of a tricuspid stenosis murmur?

A

Mid-diastolic murmur (rarely audible)

Loudest at 3rd – 4th intercostal space at the left sternal edge

Loudest during inspiration

49
Q

What are other clinical features of Tricuspid stenosis?

A

Raised JVP with giant ‘a waves’

Peripheral oedema, ascites

50
Q

Which murmurs are heard loudest on expiration?

A 
Aortic stenosis
Mitral regurgitation
Mitral Valve prolapse
Aortic regurgitation 
Mitral stenosis
51
Q

Which murmurs are heard loudest on inspiration?

A

Pulmonary stenosis
Tricuspid regurgitation
Pulmonary regurgitation
Tricuspid stenosis

52
Q

Which are systolic murmurs?

A 
Aortic stenosis 
pulmonary stenosis 
Mitral regurgitation
Tricuspid regurgitation 
Mitral valve prolapse
53
Q

Which are the diastolic murmurs?

A

Aortic regurgitation
Pulmonary regurgitation
Mitral stenosis
Tricuspid stenosis

Summer 21 SBA (11 decks)

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