Flashcards in Heart Sounds and Murmurs Deck (54):
What causes heart sounds?
Vibrations in the blood.
How many components does S1 and S2 have?
Each have 2 but normally you cannot hear them.
But splitting of heart sounds can occur (both parts are heard).
What makes up S1?
Mitral and tricuspid valves closing.
What does S1 signal?
The start of systole.
Is splitting of S1 physiological or pathological?
Commonly due to defective conduction.
What makes up S2?
Aortic and pulmonary valves closing.
What does S2 signal?
Start of diastole.
IS splitting of S2 physiological or pathological?
Aortic closure slightly proceeds pulmonary closure, so split is often heard in healthy young people, particularly on inspiration.
Large split may be related to conduction defects or high outflow pressures.
What causes S3?
Rapid ventricular filling (often heard in young people).
When end diastolic pressure is high, e.g. heart failure.
What is the timing of S3?
Is S4 physiological or pathological?
Most common cause of S4?
High end diastolic pressure.
What is the timing of S4?
Just before S1.
What is a murmur?
Audible turbulence of blood flow.
Are murmurs always pathological?
No, they can be innocent or pathological.
Describe the murmur aortic stenosis?
Ejection systolic murmur.
Describe the murmur mitral regurgitation?
Describe the murmur aortic regurgitation?
Early diastolic murmur.
Describe the murmur mitral stenosis?
Which murmurs are louder on inspiration?
Right sided murmurs.
What are the 3 most common causes of aortic stenosis?
Rheumatic heart disease
Having a congenital bicuspid valve.
What age does aortic stenosis usually present?
What 3 symptoms are associated with aortic stenosis?
What are the signs of aortic stenosis?
Low rising pulse
Heaving apex beat
Ejection systolic murmur (best heard in 2nd intercostal space on the right, which radiates to the carotids)
What changes the sound of aortic stenosis?
Squatting = louder
Standing or during valsalva manoeuvre = softer.
How might aortic stenosis present on an ECG?
Can show large QRS complexes, indicating LVH, with strain (ST depression and T wave inversion).
What are the three treatment options for aortic stenosis?
Conventional valve replacement
Trans catheter aortic valve replacement (TAVI)
Balloon aortic valvotomy (BAV)
What are the 2 types of prosthetic heart valves?
Mechanical or bioprosthetic
Which prosthetic heart valve tends to be used more in younger patients?
As they tend to last longer.
Which type of prosthetic heart valve requires anticoagulation?
What must all patients undergo before a valve replacement?
True or false.
Balloon valvuloplasty can be performed in adults.
False, it can only be performed in children without calcified valves.
Name the causes of mitral regurgitation?
- Myxomatous (floppy valve)
Ischaemic papillary rupture
Annular dilatation (caused by heart failure).
What are the symptoms of mitral regurgitation?
What are the signs of mitral regurgitation?
Displaced apex beat
Pansystolic murmur (best heard at the apex, which radiates to the axilla).
What can be seen on CXR of a patient with mitral regurgitation?
Cardiomegaly (due to volume overload and LV dilation - AF can occur as a complication).
What is the focus when managing mitral regurgitation?
Promoting LV emptying into the aorta.
What medication can be used to treat mitral regurgitation?
In mitral regurgitation, how can rheumatic valves and those affected with endocarditis be treated?
May need to be replaced by prosthetic valve.
What is aortic regurgitation?
When the valve cannot close firmly at the end of ventricular systole, so blood flows back into the ventricle from the aorta.
What are common causes of aortic regurgitation?
Connective tissue disease
What is the main symptom of aortic regurgitation?
Breathlessness (due to left ventricular failure)
What are the signs of aortic regurgitation?
Displaced apex beat
Early diastolic murmus (best heard at left sternal edge)
Often a systolic flow murmur over the aortic valve
Quincke's sign (visible nailbed pulsation)
Corrigan's sign (visible pulsation in carotids)
How might aortic regurgitation present on an ECG?
How might aortic regurgitation present on an CXR?
What imaging might be used to quantify the amount of regurgitation?
What are treatment options for aortic regurgitation?
What is the main cause of mitral stenosis?
Prior episodes of rheumatic fever
What does mitral stenosis prevent?
Free flow of blood from LA to LV during diastole.
What are the symptoms of Mitral stenosis?
What are signs of mitral stenosis?
Tapping apex beat
Mid-diastolic rumbling murmur localised to the apex.
What are treatment options for mitral stenosis patients?
Treatment of AF
Valve replacement or a balloon valvuloplasty may be required in symptomatic patients.
How do complications of mitral stenosis come about?
LA pressure rises, causing pulmonary congestion which can result in pulmonary hypertension and oedema, and right heart failure.