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Cardiology > Heart Sounds and Murmurs > Flashcards

Heart Sounds and Murmurs Flashcards

1
Q

True / False: A 3rd heart sound is always pathological

A

False - The 3rd heart sound may be physiological e.g. after exercise. It may be a sign of heart failure

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2
Q

What is the 4th heart sound representative of?

A

Atria contracting against a stiff ventricle. You cannot get a 4th heart sound if the patient is in AF as it requires atrial contraction

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3
Q

When might you hear an opening ‘snap’ heart sound?

A

Mitral stenosis

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4
Q

When might you observe a bisferians pulse?

A

HOCM

Mixed aortic valve disease

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5
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever

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6
Q

List some cause of mitral regurgitation

A

Mitral valve prolapse e.g. in connective tissue disorders (Marfan’s, Ehlers Danlos)
Rheumatic fever
Infective endocarditis
Damage to papillary muscles e.g. ischaemia, infarction
Functional e.g. in left ventricular dilatation
Annular calcification
Damage to chordae tendinae (flail mechanism)

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7
Q

What is the nature of the heart sounds ± murmur in mitral regurgitation?

A

Soft S1
Pathological S3 may be present (due to rapid filling of an enlarged left ventricle)
Pansystolic murmur, loudest at the axilla, loudest on expiration and when leaning to the left, radiates to axilla

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8
Q

What is the character of the apex beat in mitral regurgitation?

A

Thrusting

Displaced

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9
Q

Give 3 causes of aortic stenosis

A

Age related aortic valve calcification
Calcification of a bicuspid aortic valve
Rheumatic fever

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10
Q

List 4 key symptoms of aortic stenosis

A

Pre-syncope on exertion
Syncope
Angina
Exertional dyspnoea

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11
Q

What might you find on cardiovascular examination of a patient with aortic stenosis?

A

Slow rising pulse - narrow pulse pressure
Ejection systolic murmur, loudest in the aortic region, loudest on leaning forward, loudest on expiration
Murmur radiates to carotids
Displaced apex beat
Thrill may be palpable

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12
Q

Describe the characteristic pulse of aortic regurgitation

A

Collapsing, ‘water-hammer’ pulse with a wide pulse pressure

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13
Q

Describe the murmur heard in aortic regurgitation

A

Early diastolic murmur, loudest on expiration and when the patient leans forward

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14
Q

What is the most common cause of tricuspid stenosis?

A

Rheumatic fever

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15
Q

What might you find on cardiovascular examination of a patient with tricuspid regurgitation?

A

Pan systolic murmur at lower left sternal edge
Raised JVP with ‘v’ waves
Pulsatile, enlarged liver
Ascites, oedema

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16
Q

What investigations should be done for aortic stenosis?

A

ECHO to assess gradient across aortic valve

ECG to assess LVH

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17
Q

What is the treatment for aortic stenosis?

A

Aortic valve replacement

TAVI (transcatheter aortic valve implantation) in patients who are not fit for replacement

18
Q

What is meant by ‘pressure overload’ Vs. ‘volume overload’?

A

Pressure Overload: In times of high pressure, the ventricular walls hypertrophy, but the hypertrophy happens inwards, which creates further pressure. This happens until a point at which the heart can no longer compensate so heart failure occurs. There is NO displacement of the apex beat, although it is thrusting. Seen in Aortic stenosis, HOCM, coarctation of the aorta.
Volume Overload: Leaking valves cause backflow of blood into the ventricles which causes dilatation. This causes displacement of the apex beat. Happens in aortic and mitral regurgitation.

19
Q

How do you differentiate aortic stenosis from aortic sclerosis?

A

Aortic stenosis radiates to the carotids, while aortic sclerosis does not

20
Q

What is the criteria for a patient with aortic stenosis needing a valve replacement?

A

Gradient across the valve is more than 50mmHg as seen on ECHO, or if the patient is symptomatic

21
Q

What are the causes of aortic regurgitation?

A 
Remember REALM
Rheumatic heart disease
Endocarditis
Ankylosing spondylitis / aortic dissection
Leutic heart disease (tertiary syphilis)
Marfan's syndrome
22
Q

What are Corrigan’s sign and Corrigan’s pulse?

A

Corrigan’s Pulse = Collapsing pulse

Corrigan’s Sign = Collapsing pulse in the neck

23
Q

Which heart murmur is typically associated with a malar flush?

A

Mitral stenosis

24
Q

Which heart murmur is typically associated with a ‘tapping’ apex beat?

A

Mitral stenosis

25
Q

Which heart murmur is typically associated with an opening snap?

A

Mitral stenosis

26
Q

Describe the heart sounds in mitral stenosis

A

Loud S1
Opening snap
Mid-diastolic murmur, loudest in the apex
Low pitched murmur

27
Q

True / False: The apex beat is typically displaced in mitral stenosis

A

False - The apex beat is not displaced (this is pressure overload not volume overload)

28
Q

Out of aortic stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation, which murmurs are systolic and which are diastolic?

A

Aortic stenosis and mitral regurgitation = Systolic

Aortic regurgitation and mitral stenosis = Diastolic

29
Q

Which heart murmur(s) is typically associated with patients with Marfan’s?

A

Aortic regurgitation

Also mitral regurgitation due to mitral valve prolapse

30
Q

List some features of aortic regurgitation

A

Waterhammer (bounding)
Collapsing (Corrigan’s) pulse
Corrigan’s sign i.e. collapsing pulse in the neck
Wide pulse pressure
JVP not raised
Displaced apex beat
Soft, diastolic murmur, loudest in aortic region ‘Lub tarrrrr’

31
Q

Which murmur might be accentuated when the patient rises from a squatting position to a standing?

A

Mitral regurgitation

32
Q

List the features of mitral stenosis

A 
Malar flush
AF
JVP not raised until late
Apex beat 'tapping', not displaced
Opening 'snap'
Mid-diastolic, low-pitched murmur loudest at apex
Signs of left ventricular failure
33
Q

What is the usual causative organism of rheumatic heart disease?

A

Starts as bacterial tonsillitis caused by strep pyogenes (group A beta-haemolytic strep)

34
Q

How might you differentiate between aortic stenosis and pulmonary stenosis?

A

Aortic stenosis = Loudest on expiration, radiates to carotids
Pulmonary stenosis = Loudest on inspiration, unlikely to radiate

35
Q

List 5 causes of systolic murmurs

A

Aortic stenosis
Pulmonary stenosis
Mitral regurgitation
Tricuspid regurgitation

36
Q

How might you differentiate between mitral regurgitation and tricuspid regurgitation?

A

Mitral regurgitation = Loudest on expiration, radiates to axilla
Tricuspid regurgitation = Loudest on inspiration, unlikely to radiate

37
Q

Which heart sound would be affected in a mitral valve replacement?

A

S1

38
Q

Which heart sound would be affected in an aortic valve replacement?

A

S2

39
Q

What type of material are prosthetic heart valves made from?

A

Tissue valve = Porcine

Mechanical heart valve

40
Q

List some complications of prothetic heart valves

A

Embolus (patients need to be on warfarin)
Over-warfarinisation i.e. bleeding
Endocarditis
Leaking valves

41
Q

What is the target INR for a patient with a mechanical heart valve?

A

3-4

42
Q

Which patients tend to be given mechanical heart valves rather than tissue?

A

Younger patients get mechanical valves as they last longer

Cardiology (4 decks)

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