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25 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Describing a murmur |
TIP-PQRS - timing - intensity - position of stethoscope - position of patient - quality - radiation - systemic feature |
7 |
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Timing of a murmur |
Systolic murmurs - pansystolic: heard throughout systole (MR, tricuspid regurgitation) - ejection systolic: crescendo-decrescendo, wane late (AS, PS) Diastolic murmurs are rare |
3 |
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Intensity of a murmur |
- grade I: only audible to consultants - grade II: soft - grade III: moderate - grade IV: thrill just palpable - grade V: thrill easily palpable - grade VI: audible without a stethoscope |
6 |
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Position of stethoscope |
- aortic area: AS - mitral area: MR |
2 |
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Position of the patient - breathing |
- left lateral position & exhalation (bell): MR - sitting forward & exhalation, left sternal edge (bell): AS - inspiration: right-sided murmurs are louder (AS) - expiration: left-sided murmurs are louder (MR) |
4 |
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Quality of the murmur |
- blowing: MR - soft 2nd heart sound, crescendo-decrescendo: AS |
2 |
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Radiation of the murmur |
- carotids: AS, ask patient to hold breath (bell) - axilla: MR |
2 |
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Systemic features of a murmur |
- other heart sounds - apex beat - pulse |
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Causes of AS |
- senile calfication: most common, 60+yrs - congenital: bicuspid valve, Williams syndrome - rheumatic fever |
3 |
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Symptoms of AS |
- triad: angina, dyspnoea, syncope (exercise) - LV failure: PND, orthopnoea, frothy sputum - arryhthmias - systemic emboli: IE - sudden death |
5 |
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Signs of AS |
- slow rising pulse, with narrow pulse pressure - aortic thrill - forceful apex beat (non-displaced) - quiet second heart sound |
4 |
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DDx in AS |
- CAD - MR - aortic sclerosis - HOCM |
4 |
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Investigations in AS |
- ECG: LVH - CXR: calcified valve, HF - echo & Doppler: diagnostic - angiography - exercise stress test |
5 |
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Management of AS |
- mechanical valves |
1 |
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Causes of MR |
- rheumatic heart disease - IE - valve prolapse - papillary muscle rupture (MI) - LV dilation: AT, AS, HTN - connective tissue disorders: Marfan's syndrome, Ehler-Danlos, SLE |
6 |
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Symptoms of MR |
- dyspnoea - fatigue - AF: palpitations, emboli - pulmonary congestion: HTN, oedema |
4 |
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Signs of MR |
- AF - left parasternal heave (RVH) - displaced apex |
3 |
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DDx in MR |
- AS - TR - VSD |
3 |
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Investigations in MR |
- ECG - CXR: hypertrophy, calcified valve, pulmonary oedema - echo - angiography |
4 |
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Barlow syndrome |
Mitral valve prolapse - audible click |
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Metallic heart valve clinical features |
- click (S1 for mitral, S2 for aortic) - may be audible without stethoscope |
2 |
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Assessing metallic valves |
- function: regurgitation (systolic murmurs are normal) - signs of HF - signs of infective endocarditis |
3 |
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Indications for metallic valves
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- left-sided valve dysfunction - infective endocarditis * MR valve replacement & MS balloon valvuloplasty is preferred unless CI |
3 |
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Complications of metallic valves |
- leakage
- dehiscence - obstruction - VTE - haemolytic anaemia - infective endocarditis |
6 |
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Warfarin therapy in metallic valves
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Target INR: 2-3 |
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