Murmur/valvular disorders Flashcards
(39 cards)
aortic stenosis murmur
ejection systolic murmur
high pitched
crescendo decrescendo
Radiates to carotid
Where is aortic stenosis best heard
Best heard in arotic area,right parasternal 2nd intercostal space.
Laouder on expiration
Causes of aortic stenosis
congenital aortic stenosis ( rare, infancy)
Premature calcification of bicuspid valve ( common, 30-40y)
Calcification of a normal/tricuspid valve ( most common, 65y)
aortic stenosis features
slow rising pulse
narrow pulse pressure
1. dizziness.syncope
2. effort dyspnoea
3. effort angina/palpitations
Aortic stenosis management
ECHO to monitor/assess severity
Surgery
- conventional
- TAVI (used in surgery high risk/elderly)
mitral regurgitation murmur
loud pan systolic murmur at apex
high pitched whistle
radiates to axilla
loudness associated with severity
louder on expiration
Additional mitral regurgitation features
Asymptomatic for many years, presentation picture of HF, displaced and diffuse apex beat resulting from vol overload,
Causes of mitral regurgitation
- Intrinsic valve problems eg rheumatic heart disease, IE,chordal rupture/prolapse, papillary muscle rupture ,IHD, connective tissue disorders
- Secondary/functional (LV dysfunction results in its dilation)
Mitral regurgitation management
Medical HF therapy (diuretic, ACEi)
Surgery for mitral valve repair or replacement
Aortic regurgitation murmur
early soft diastolic decrescendo murmur
loudness is marker of severity
best heard if patient sits forward at left sternal edge
How to hear aortic regurgitation best
heard best left sternal edge, 3/4th IC space
Patient leans forward, breathes in , holds, breaths out and will hear it in end expiration
aortic regurgitation features
~~~
collapsing/water hopper pulse
wide pulse pressure
quinces sign
head bobbing (de mussels)
Austin flint murmur
corrigans
duroziez murmur
pistol shot femorals
markers of severity
Causes of aortic regurgitation
- Diseases affecting aortic valve eg rheumatic heart disease, iE, SLE
- Diseases resulting in dilation of aortic root eg aortic aneurysm, Marfan,ankylosign spondylitis,syphilis
- Acute cause could be aortic dissection
Aortic regurgitation Mx
Medical therapy ( HF)
Surgery (conventional aortic valve replacement)
mitral stenosis murmur
low pitched rumbling mid diastolic murmur
best heard if patient is on left side and listen at apex
best heard at apex if patient lays on left hand side
mitral stenosis features
AF
RV heave due to p. HTN
malar flush
graham steel murmur (pulmonary regurgitation, again high-pitched and ‘blowing’ in character)
Causes of mitral stenosis
Mainly rheumatic disease
Mitral stenosis management
Medical therapy (diuretics, and rate control/anitcoag if AF)
Surgery
- mitral vagotomy
- mitral valve replacement
S4
abnormal
stiff/hypertrophic ventricle
HF, ischameia, cardiomyopathy, post MI fibrosis
heard in late diastole
TEN-NE-SSEE
S4-S1-S2
https://www.youtube.com/watch?v=KcMF8rJDTIk
Which are systolic and diastolic murmurs
MR AS-S
AR MS-D
S3
Can be normal in young/athlete/pregnancy
Abnormal in elderly (cardiomyopathy, HF, mitral or tricuspid regurgitation)
KEN-TUCK-KY
S1-S2-S3
https://www.youtube.com/watch?v=_i2D1KZkN1w
Atrial septal defects
ejection systolic murmur louder on inspiration
fixed split S2
many are asymptomatic in childhood if untreated then produce symptoms when adult
Mitral valve prolapse murmur
midsystolic
louder on expiration rather than inspiration.
Still’s/innocent murmur
common quiet systolic murmur heard in young children
do not progress to give symptoms
generally cannot be heard into adulthood.
