Heart murmurs Flashcards Preview

Last-minute Finals > Heart murmurs > Flashcards

Flashcards in Heart murmurs Deck (32)
Loading flashcards...
1
Q

Aortic stenosis signs

A

Pulse = slow, low, narrow

slow-rising pulse
low volume pulse
narrow pulse pressure

Apex beat is forceful but not displaced
heaving, pressure overload

Thrill in aortic area

4th heart sound

2
Q

Aortic stenosis murmur

A

ejection systolic

crescendo-decrescendo

loudest in aortic area

radiates to carotids

if very severe, A2 is quietened

3
Q

Causes of Aortic stenosis

A

Degenerative calcification of a normal aortic vale
Rheumatic heart disease
Bicuspid aortic valve (congenital)

4
Q

Treatment of Aortic stenosis

A

Be guided by the symptoms as to the severity (exercise-induced syncope, angina, SOB)

Valve replacement
TAVI (transcatheter aortic valve insertion)

5
Q

Causes of pressure overload to LV

A

hypertension

Aortic stenosis

coarctation of aorta

hypertrophic cardiomyopathy with LVOT obstruction

6
Q

Aortic stenosis differential diagnoses

A

HOCM
VSD
Aortic sclerosis (no radiation of murmur, normal pulse character)
Aortic flow murmur (high output clinical states - pregnancy, anaemia, infection)

7
Q

Stages of clubbing

A

Increased fluctuancy of the nail bed

Loss of angle between nail and nail bed

Increased curvature of the nail

Expansion of the terminal phalanx

8
Q

Third heart sound

A

Normal up to 30Y

Lub Dub Ba

Blood rushing in during the rapid filling phase of early diastole

Overly compliant/dilated ventricle

9
Q

Fourth heart sound

A

Le Lub Dub

Atria contracting against a non-compliant/hypertrophied ventricle

Low-pitched sound

Always always abnormal

10
Q

Causes of fourth heart sound

A
hypertrophic cardiomyopathy
hypertension (pressure overload)
aortic stenosis
heart failure
MI
11
Q

Causes of third heart sound

A
heart failure
MI
dilated cardiomyopathy
hypertension (pressure overload)
co-existing mitral or aortic regurgitation (volume overload)
constrictive pericarditis
12
Q

Causes of atrial fibrillation

A

Ischaemic heart disease
Rheumatic heart disease
Thyrotoxicosis

13
Q

Causes of irregularly irregular pulse

A

Atrial fibrillation

Multiple ventricular ectopics

Do an exercise test: there will be fewer ectopics as the heart rate increases

14
Q

What is the pulse deficit in AF and why does it happen

A

increased rate = reduced diastolic filling time
some ventricular contractions will happen very close together
so there isn’t enough time for the ventricles to fill enough to produce an actual cardiac output
which means that there is no palpable pulse for that beat
BUT, there is enough blood flow to move the valves, so you will still hear the heart sounds

Time the apical rate with stethoscope
<80bpm is good control

15
Q

INR target in 1) AF 2) Mechanical prosthetic valve

A

AF with warfarin = 2-3

Prosthetic valve = 3-4

16
Q

Difference in pathophysiology of aortic stenosis and aortic sclerosis

A

STENOSIS
fusion of commisures
narrowing of orifice

SCLEROSIS
thickening of leaflets leading to turbulent blood flow which causes a loud ejection systolic murmur
normal orifice

17
Q

Mitral regurgitation causes

A

LEAFLET
congenital
endocarditis
degenerative

PAPILLARY MUSCLE AND CHORDAE
mitral valve prolapse
acute coronary syndrome
Marfan’s

ANNULAR DILATATION
cardiomyopathy
ischaemic heart disease with heart failure

18
Q

Mitral regurgitation signs

A

Displaced apex beat (volume overload)
Quiet first heart sound
Second heart sound not heart separately and distinctly

19
Q

Mitral regurgitation murmur

A

Pansystolic murmur

Radiates loudly to axilla

brrrrrrrrrrrrrrrrrr

20
Q

Why do you get a displaced apex beat in Mitral regurgitation

A

Volume overload because:

Blood goes back into atrium during ventricular systole, and this extra volume returns back to the LV during diastole, leading to LV dilatation

21
Q

Mitral regurgitation treatment

A

Mild/moderate: ACEinhibitors (reduce afterload), diuretics, anticoagulants if needed

Severe = valve repair (not replacement)

22
Q

Mitral stenosis signs

A

Malar flush

atrial fibrillation

loud first heart sound

tapping apex beat, not displaced

JVP is only raised very late

CXR: prominent left atrium, has a convex edge

23
Q

Mitral stenosis murmur and sounds

A

LOUD first heart sound

opening snap = high pitched sound just after second heart sound (listen at LLSE)

mid-diastolic murmur

LUB de durrrrrrrrrrrrrrr

24
Q

Mitral stenosis causes

A

Rheumatic heart disease

25
Q

Mitral stenosis treatment

A

Mild: meds - anticoagulate, diuretics, rate control of any AF

Moderate: trans-septal valvuloplasty, valve replacement

Severe: valve replacement (based on objective measured area of the valve combined with pressure gradient across the valve)

26
Q

Aortic regurgitation signs

A

displaced apex beat (volume overload)

wide pulse pressure

Corrigan’s sign = collapsing pulse
Quinke’s sign = nailbed pulsation
De Musset’s sign = head’nodding
Traube’s sign = pistol-shot femorals

27
Q

Aortic regurgitation murmur

A

Early diastolic murmur after second heart sound

Heart best in aortic area, leaning forward, breath held in expiration

Lub taaaaaaaarrrrrr

28
Q

Aortic regurgitation causes

A

R - rheumatic heart disease

E - endocarditis (vegetations can perforate leaflet)

A - ankylosing spondylitis

L - luetic heart disease (=syphilis)

M - Marfan’s (also arachnodactyly, high-arched palate)

29
Q

Aortic regurgitation treatment

A

If significant regurgitation present, valve replacement

30
Q

Indications for ICD (Implantable Cardiac Defibrillator)

A

Sudden cardiac death: Primary prophylaxis

  • familial cardiac condition with high risk of sudden death (long QT syndrome, HOCM, Brugada syndroma)
  • surgical repair of congenital heart disease

Secondary prophylaxis

  • previous cardiac arrest caused by VT/VF
  • spontaneous sustained VT causing cyncope/sustained haemodynamic compromise
31
Q

Indications for pacemaker

A
SYMPTOMATIC:
bradycardia
third degree heart block
second degree heart block (type II)
alternating bundle branch block

cardiac resynchronisation therapy with biventricular pacing

32
Q

Types of pacemaker

A

Unipolar

  • used when AV conduction is likely to return/recover
  • if there is normal AV conduction but a sinoatrial disorder, then pacing wire in RA

Bipolar/dual-chamber

  • pacing electrodes in both RA and RV
  • allow maintenance of physiological relationship between atrial and ventricular contraction
  • allow paced heart to increase sinus rhythm like in exercise

Biventricular
- leads in RA, RV and LV