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Flashcards in Heart sounds and murmurs Deck (22)
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What do the normal heart sounds represent?

  • S1 "lub": closure of mitral & tricuspid valves
  • S2 "dub": closure of aortic & pulmonary valves


Explain a third heart sound (S3)

  • Blood entering stiff/dilated ventricles during early diastole
  • S3 due to decelerated blood flow at ventricular elastic limit
  • Low-frequency brief vibration


Give two causes of a third heart sound

Normal in children and young adults (<30)

  • Heart failure
  • MI
  • Cardiomyopathy
  • HTN


Explain a fourth heart sound

  • Atrial contraction into non-compliant/hypertrophied ventricle
  • Low pitched 'Gallop' at end diastole


Give two causes for a fourth heart sound

Always abnormal

  • Heart failure
  • MI
  • Cardiomyopathy
  • HTN


What are the important features when describing a murmur?

  • Systolic or diastolic
  • Pan/Ejection/Mid
  • Where it is heard best
  • Where it radiates to


How does ventilation affect auscultation of murmurs?

  • Inspiration: vice-versa for expiration
    • Increases venous return to right side of heart
    • Decreases pulmonary return to left side of heart
  • Therefore:
    • Right-sided murmurs (T/P) louder on inspiration
    • Left-sided murmurs (M/A) louder on expiration


Outline the grading of murmurs


Describe the auscultation findings of mitral stenosis

  • 'Rumbling' mid-diastolic murmur
    • Bell at apex; pt lying on left side
  • Loud S1
  • 'Opening snap'


Name two signs (other than on auscultation) of mitral stenosis

  • Malar flush
  • Low volume pulse
  • AF
  • CXR
    • Enlarged left atrium
    • Pulmonary oedema


Name one cause of mitral stenosis

  • Rheumatic heart disease
  • Old age; calcification


Describe the auscultation findings of mitral regurgitation

  • Pansystolic "blowing" mumur
  • Radiating to axilla


Name two signs (besides auscultation) of mitral regurgitation

  • Malar flush
  • Displaced apex beat
  • Palpable thrill


Give two causes of mitral regurgitation

  • Prolapsing mitral valve
  • Rheumatic mitral regurgitation
  • Papillary muscle rupture post-MI
  • Cardiomyopathy
  • Connective tissue disorders:
    • Marfan's syndrome
    • Ehlers Danlos
    • Osteogenesis imperfecta


Describe the auscultation findings of aortic stenosis

  • Ejection systolic murmur
  • Radiating to carotids


Give two signs (besides auscultation) of aortic stenosis

  • Slow rising pulse
  • Narrow pulse pressure
  • Forceful apex beat


Name two causes of aortic stenosis

  • Bicuspid aortic valve
  • Age-related calcification
  • Rheumatic fever


Provide three presenting features of aortic stenosis

  • Asymptomatic
  • Exercise-induced:
    • Syncope
    • Angina
    • Dyspnoea


Describe the auscultation findings of aortic regurgitation

  • High-pitched early diastolic murmur
  • Best heard at left sternal edge in 4th intercostal space
  • Patient lent forward


Give two signs (besides auscultation) of aortic regurgitation

  • Collapsing pulse: wide pulse pressure
  • Quincke's sign: capillary pulsation in nail beds
  • De Musset's sign: head nodding with heartbeat
  • Pistol shot femorals


Give two causes of aortic regurgitation

  • Rheumatic fever
  • Bicuspid valve
  • Infective endocarditis
  • Marfan's syndrome
  • Tertiary syphilis


Outline the treatment of aortic stenosis

  • Diuretics for symptomatic relief
  • SAVR or TAVI
  • Balloon valvuloplasty pre-TAVI