Flashcards in Heart Murmurs & Ischemia Deck (57)
What happens during S1 in the cardiac cycle?
Closure of the mitral & tricuspid valves
What happens during S2 of the cardiac cycle?
Closure of the pulmonic aortic & pulmonic valves
Do the mitral & tricuspid valve open right after S1 or S2?
What is the most common cause of murmurs?
disease of heart valve
What are the 2 main mechanisms of murmurs?
1. Obstructed flow due to stenotic valve
2. Backwards flow through a leaky valve= regurgitation (aka insufficiency)
What are the 3 types of systolic murmurs?
- Mitral regurgitation (MR)
- Mitral valve prolapse (MVP)
- Aortic stenosis (AS)
What are the 2 diastolic murmurs?
Mitral stenosis (MS)
Aortic regurgitation (AR)
What artery pulse could you use to help you determine S1 and S2?
Does the carotid pulse occur during systole or diastole?
S1 --> carotid pulse --> S2
Which valve is being described? Closed during systole, blood cannot flow backwards from LV to LA
Normal Mitral Valve
What happens during mitral regurgitation?
mitral valve allows backwards blood flow from LV to LV during ALL of systole.
AKA- holosystolic (pansystolic) murmur
When does mitral regurgitation occur during the cardiac cycle? What is the intensity like?
Occurs from S1 to S2
Same intensity throughout the murmur- doesn't change
Where is mitral regurgitation best heard? Where might it radiate?
May radiate to axilla or posterior lung bases
What are the causes of mitral regurgitation?
Rheumatic heart disease (immigrants)
CT diseases (ex= Marfans)
Mitral Valve Prolapse
Explain a mitral valve prolapse.
Redundant valve tissue with elongated chordae tendinae so the valve balloons up into the LA.
This causes an upward displacement of the mitral valve leaflets during systole
What is heard during a MVP? Where do you hear this best?
Mid-systolic click/ late systolic murmur
Is aortic stenosis heard during systole or diastole?
known as a systolic ejection murmur
What does an aortic stenosis murmur sound like and where is it best heard? Radiates?
- intensity increases then decreases again during systole
- 2nd right intercostal space
- radiates to the neck or heart apex
What are the causes of aortic stenosis?
- congenital bicuspid valve (should be tricuspid)
- more susceptible to wear & tear
- calcific degeneration (in patients over 70)
What are the symptoms of aortic stenosis?
- Dyspnea on exertion- 75%
- Angina- 10%
- Presyncope- 10% / Syncope- 5%
How would aortic stenosis lead to heart failure?
Left ventricular outflow obstruction leads to left ventricular hypertrophy --> could lead to heart failure
Explain aortic regurgitation
due to retrograde flow of blood from aorta into the LV- the valve is supposed to be closed but is leaky
When do you hear aortic regurgitation and where is it best heard?
Early diastolic descrescendo murmur
- lower left sternal border- may get patient to lean forward & hold breath
What are causes of aortic regurgitation
Congenital bicuspid valve
Rheumatic heart disease
What can aortic regurgitation lead to?
- volume overload in LV
- combined LV hypertrophy & dilation
- heart failure
Explain mitral stenosis
partially obstructed flow of blood from LA to LV
What does mitral stenosis sound like and where is it best heard? Radiate?
- opening snap followed by a decrescendo diastolic rumble
- may have patient lie on left side
** doesn't radiate
What can mitral stenosis lead to?
- Elevated left atrial pressure
- pulmonary hypertension
- eventually right sided heart failure
( blood backs up into lungs causing R sided heart problems)
What is the common cause of mitral stenosis?