osces and heart murmurs by joshua bower peer revision 2013/14
TRANSCRIPT
OSCEs and Heart Murmurs
By Joshua BowerPeer Revision 2013/14
AS MR ARMS says…
• AS – ejection systolic
• MR – pansystolic
• AR – early diastolic• MS – mid-diastolic
What does this mean: I + II + O
• Heart sounds I and II present• O means no other sounds (i.e. no murmur)
What is the mechanism behind the 3rd heart sound? Give TWO differentials
• Rapid ventricular filling• May be normal in <30yo• Think volume overload– CCF– MR– AR– Anterior MI
What is the mechanism behind the 4th heart sound? Give TWO differentials
• Due to poorly compliant ventricle• Never normal• Think pressure overload– AS– HTN– Post-MI fibrosis
Give THREE differentials for an irregularly irregular pulse
• AF• Ventricular ectopic beats• Complete heart block
• To differentiate AF and VEBs without an ECG, get the patient to exercise – AF will remain but VEBs will be abolished
List FOUR important causes of AF
• IHD• Rheumatic heart disease• Thyrotoxicosis• Pneumonia• PE• Alcohol
Sorry for the poor quality… if it’s unreadable send me a message and I’ll type it up ([email protected])