Heart sound in patient with hx of surgery for mitral valve prolapse

[rose2012]

Hello,

I had a patient whose chart indicated that he had had surgery in the past for a mitral valve prolapse. He was running very high blood pressures following orthopedic surgery. When auscultating his heart sounds, I heard a strong whooshing sound at the apex. None of the preceding shift nurses had indicated in their assessment documentation anything other then "S1, S2 regular." I'm wondering if anyone can tell me, perhaps a cardiac nurse, whether it makes sense that the patient would have an abnormal heart sound such as a woosh (murmur sound) following surgery for MVP.

Thanks for any input.

[Esme12, ASN, BSN, RN]

hummmm...depends on the surgery he had....what you may be hearing is a murmur. At the apex would be mitral regurgitation. If the valve was only repaired there cold be some functional murmur left.

Simple explanation....Family Doctor

Intense explanation....Auscultation of the Heart

[rose2012]

Thank you, Esme12!

[Esme12, ASN, BSN, RN]

you are welcome! There are some great heat tone videos on You tube.https://www.youtube.com/watch?v=MMJBSd5Z_Uc

[nurseprnRN, BSN, RN]

Systolic whoosh (mitral regurg or aortic stenosis), or diastolic whoosh (aortic regurg, or mitral stenosis), or both? Makes a difference. Apex is most likely to be a mitral sound, one way or another.

Any chance that he has something else going on, like an aneurysm?

[Esme12, ASN, BSN, RN]

Ventricular aneurysm....I haven't seen one of those in years....man when they blew those patients went blue from the nipple line up instantly, they would look at you, roll their eyes back and POOF! they were gone.

Since the onset of thrombolytics and invasive interventions seeing them has dropped dramatically.

OP good ear by the way.

[Lev, MSN, RN, NP]

I'm sure S1 and S2 were regular, but either the nurses did not pick up the murmer, did not recognize it as a murmer, or were not sure if it was murmer and decided to "underchart" rather than possibly chart incorrectly. PS if the patient had a cardiology consult, look there the see the cardiologist's perspective.

[nurseprnRN, BSN, RN]

Ventricular aneurysm....I haven't seen one of those in years....man when they blew those patients went blue from the nipple line up instantly, they would look at you, roll their eyes back and POOF! they were gone.

Since the onset of thrombolytics and invasive interventions seeing them has dropped dramatically.

OP good ear by the way.

Great visuals. I remember that... worked a good while in a CV surgery ICU. That's what I was thinking of with a pansystolic murmur- the ventricle that stretches out so far that the mitral valve never works again. Tends to be a really loud murmur, but like all bleeding, it stops. Eventually.

OP, even if nobody else has charted what you heard, make sure (if this ever happens again) that you get somebody who's really good c heart sounds to come and listen right away. You might just be the first person who heard his murmur. Here's hoping you aren't...the last.

[Esme12, ASN, BSN, RN]

Great visuals. I remember that... worked a good while in a CV surgery ICU. That's what I was thinking of with a pansystolic murmur- the ventricle that stretches out so far that the mitral valve never works again. Tends to be a really loud murmur, but like all bleeding, it stops. Eventually.

OP, even if nobody else has charted what you heard, make sure (if this ever happens again) that you get somebody who's really good c heart sounds to come and listen right away. You might just be the first person who heard his murmur. Here's hoping you aren't...the last.

When they blow the papillary muscle....thats another instant crump/cardiogenic shock.

OO the new development of a murmur in the setting of an acute MI, particular to the anterior wall MI... can be an ominous sign.