Heart Murmurs

In part two of our series of heart sounds we look at the most common murmurs (audio-examples included)

 

Lecture by

Video Duration: 18 minutes

  • Mitral Stenosis
    Created by rozel
    General
    Epidemiology

    A rumbling mid-diastolic murmur which can radiate to the axilla.

    Pathology

    The narrow valve leads to increasing left atria pressure. This then leads to a loud S1 and atrial hypertrophy, leading into Atrial Fibrillation. There is increased pulmonary vascular resistance leading to pulmonary hypertension, giving pulmonary oedema. Due to this there is right ventricular hypertrophy ultimately leading into heart failure.

    Top three causes

    1. Rheumatic Fever

    2. Prosethetic Valve

    3. Congenital

    Clinical Features
    Symptoms

    Symptoms manifest when the valve opening is less than 2cm.

    Dyspnoea

    Fatigue

    Chest pain

    These are suggestive that the patient has decompensated

    Signs

    Malar flush

    JVP may be raised late on

    􏰄Left parasternal heave

    Apex: Tapping (palpable S1), non-displaced

    􏰄 Heart sounds:

    • 􏰅Loud S1
    • Loud P2 (if have Pulmonary Hypertension)
    • Early diastolic opening snap

    Murmur:

    • Rumbling mid diastolic murmour at􏰅 apex
    • Radiates to the axilla
    􏰅
    Investigations
    Cultures

    None

    Bloods

    None

    Imaging

    Echocardiogram- transthoracic or transoesophageal (To grade the severity of the stenosis. Trans-oesophageal can be used to screen for vegetation on the diseased valve)

    Chest X ray (looking for signs of heart failure i.e pulmonary oedema. The valve may also be calcified which would be visible on xray)

    Scopic/Biopsy

    None

    Functional

    ECG (would possibly see Atrial Fibrillation, P mitrale, or a right venticular strain pattern)

    Treatment
    Conservative

    If not sympotmatic:

    • Avoid rigourous exertion
    • Regular follow-up
    Medical

    Optimise risk factors for CVD:

    • Antihypertensives
    • Statins
    • Diabetes

    For Atrial Fibrillation: rate control and anti-coagulate.



    Surgical

    Indicated if moderate or severe

    First line is percutaneous balloon valvuloplasty. This depends on the valve being pliable and minimaly calcified.

    A valve repair is then considered if not then valve replacement is done.