Flashcards in Heart sounds and cardiac murmurs Deck (29)
What causes the first heart sound?
Closure of the mitral and tricuspid valves at the end of diastole
What causes the second heart sound?
Closure of the aortic and pulmonary valves at the end of systole
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
When does a third heart sound occur?
The third heart sound is an early diastolic filling sound occurring immediately after the second heart sound
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
When does a fourth heart sound occur?
This is a late diastolic heart sound
What does a fourth heart sound indicate?
Active filling of ventricle i.e. stiff ventricle
What five things should a full description of any cardiac murmur include?
Character & pitch
What causes an innocent murmur?
Systolic flow murmur usually caused by turbulent bloodflow in the right ventricular outflow tract
What are the characteristics of an innocent murmur?
Usually heard in pulmonary area
No other cardiac abnormalities
Which murmur is an ejection systolic murmur?
Which murmur does a slow rising pulse indicate?
Which murmur does a collapsing pulse indicate?
Which murmur does the presence of a malar flush indicate?
Which murmur is a pan systolic murmur?
Which murmur does a tapping apex beat indicate?
Where is the murmur of aortic stenosis best heard?
Where might the murmur of aortic stenosis radiate to?
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
What are some of the symptoms of aortic stenosis?
Breathlessness, syncope, chest pain
Which murmur might displace the apex beat?
Where might the murmur of mitral regurgitation radiate to?
What are some of the causes of mitral regurgitation?
Rheumatic heart disease
Floppy mitral valve syndrome
Ischaemia or infarction of papillary muscle
Left ventricular englargement
Which murmur is a mid-diastolic murmur?
Which murmur is an early diastolic murmur?
Which murmur is associated with right sided heart failure?
What are some of the symptoms of mitral stenosis?
What are some of the causes of aortic regurgitation?
Leaflets due to endocarditis
Rheumatic heart disease