Heart sounds and cardiac murmurs Flashcards Preview

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Flashcards in Heart sounds and cardiac murmurs Deck (29)
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1

What causes the first heart sound?

Closure of the mitral and tricuspid valves at the end of diastole

2

What causes the second heart sound?

Closure of the aortic and pulmonary valves at the end of systole

3

What causes the physiological splitting of the second heart sound and when does it occur?

Occurs during inspiration - inspiration increases the intrathoracic pressure and so venous return to the right side of the heart is increased
The right ventricular volume will be increased, and so the pulmonary valve closure may be slightly later than the aortic valve closure, producing the splitting of the second heart sound

4

When does a third heart sound occur?

The third heart sound is an early diastolic filling sound occurring immediately after the second heart sound

5

What causes a third heart sound?

Acceleration and deceleration of blood during early passive filling of the ventricle
May be physiological in otherwise healthy young patients
Likely to be pathological in older patients - indicated left ventricular systolic dysfunction

6

When does a fourth heart sound occur?

This is a late diastolic heart sound

7

What does a fourth heart sound indicate?

Active filling of ventricle i.e. stiff ventricle
Aortic stensosis
Hypertension
Ischaemia

8

What five things should a full description of any cardiac murmur include?

Intensity/grading
Character & pitch
Timing
Location
Radiation

9

What causes an innocent murmur?

Systolic flow murmur usually caused by turbulent bloodflow in the right ventricular outflow tract

10

What are the characteristics of an innocent murmur?

Systolic
Soft
Usually heard in pulmonary area
Localised/no radiation
No other cardiac abnormalities

11

Which murmur is an ejection systolic murmur?

Aortic stenosis

12

Which murmur does a slow rising pulse indicate?

Aortic stenosis

13

Which murmur does a collapsing pulse indicate?

Aortic regurgitation

14

Which murmur does the presence of a malar flush indicate?

Mitral stenosis

15

Which murmur is a pan systolic murmur?

Mitral regurgitation

16

Which murmur does a tapping apex beat indicate?

Mitral stenosis

17

Where is the murmur of aortic stenosis best heard?

Aortic area

18

Where might the murmur of aortic stenosis radiate to?

Carotids

19

How can you distinguish between aortic stenosis murmur radiating to the carotids or carotid bruit?

If there is no murmur audible in the precordium, it Is a carotid bruit

20

What are some of the symptoms of aortic stenosis?

Breathlessness, syncope, chest pain

21

Which murmur might displace the apex beat?

Mitral regurgitation

22

Where might the murmur of mitral regurgitation radiate to?

Axilla

23

What are some of the causes of mitral regurgitation?

Rheumatic heart disease
Floppy mitral valve syndrome
Endocarditis
Chordae rupture
Ischaemia or infarction of papillary muscle
Left ventricular englargement

24

Which murmur is a mid-diastolic murmur?

Mitral stenosis

25

Which murmur is an early diastolic murmur?

Aortic regurgitation

26

Which murmur is associated with right sided heart failure?

Mitral stenosis

27

What are some of the symptoms of mitral stenosis?

Fatigue
Breathlessness
Palpitations

28

What are some of the causes of aortic regurgitation?

Marfan's syndrome
Leaflets due to endocarditis
Rheumatic heart disease

29

Which murmur is associated with cardiac cachexia?

Mitral stenosis