Heart murmurs

Question 1

Aortic stenosis murmur name

Answer 1

ejection systolic murmur

Question 2

Where is aortic stenosis murmur loudest?

Answer 2

over aortic valve

Question 3

Where can an aortic stenosis murmur radiate?

Answer 3

carotid arteries

Question 4

Causes of aortic stenosis

Answer 4

calcification of aortic valves (mainly in the elderly)
congenital abnormality of aortic valve (bicuspid)
rheumatic heart disease

Question 5

How can aortic stenosis murmur be accentuated?

Answer 5

sitting forwards
expiration

Question 6

Clinical features of aortic stenosis

Answer 6

slow rising pulse
narrow pulse pressure
non-displaced, heaving apex beat (indicates left ventricular hypertrophy)
reduced or absent S2
Reverse splitting of S2 (aortic valve closes after pulmonary valve)

Question 7

Mitral regurgitation murmur name

Answer 7

pansystolic murmur

Question 8

Where is mitral regurgitation murmur loudest?

Answer 8

over mitral area

Question 9

Where can mitral regurgitation murmur radiate?

Answer 9

axilla

Question 10

Causes of mitral regurgitation

Answer 10

infective endocarditis
acute MI with rupture of papillary muscles
rheumatic heart disease
congenital defects of mitral valve
cardiomyopathy

Question 11

How can mitral regurgitation murmur be accentuated?

Answer 11

expiration
left lateral decubitus position

Question 12

Clinical feature of mitral regurgitation

Answer 12

displaced, hyperdynamic apex beat

Question 13

Aortic regurgitation murmur name

Answer 13

early diastolic murmur

Question 14

Where is aortic regurgitation murmur heard loudest?

Answer 14

left sternal edge

Question 15

What diseases affecting the valve can cause aortic regurgitation?

Answer 15

congenital bicuspid aortic valve
rheumatic heart disease
infective endocarditis

Question 16

What diseases causing aortic root dilatation can cause aortic regurgitation?

Answer 16

aortic dissection
connective tissue diseases (eg. Marfan’s)
aortitis

Question 17

Clinical features of aortic regurgitation

Answer 17

collapsing pulse
displaced, hyperdynamic apex beat

Question 18

What is an Austin Flint murmur and what is it a sign of?

Answer 18

low pitched rumbling mid diastolic murmur heard best at the apex
caused by regurgitated blood through the aortic valve mixing with blood from the left atrium during atrial contraction

sign of severe aortic regurgitation

Question 19

Eponymous clinical signs of aortic regurgitation

Answer 19

Corrigan’s sign = visible distention and collapse of carotid arteries in the neck

De Musset’s sign = head bobbing with each heartbeat

Quincke’s sign = pulsations are seen in the nail bed with each heartbeat when the nail bed is lightly compressed

Traube’s sign = ‘pistol shot’ sound heard when stethoscope placed over the femoral artery during systole and diastole

Muller’s sign = uvula pulsations are seen with each heartbeat

Question 20

Mitral stenosis murmur name

Answer 20

mid-diastolic murmur

Question 21

Where is mitral stenosis murmur loudest?

Answer 21

over apex

Question 22

What can cause mitral stenosis?

Answer 22

rheumatic heart disease = most common

rarer causes:
- congenital
- left atrial myxoma
- connective tissue disorders
- mucopolysaccharidosis

Question 23

How can mitral stenosis murmur be accentuated?

Answer 23

left lateral decubitus position
expiration

Question 24

What does RILE mean?

Answer 24

right inspiration
left expiration

murmurs from left-sided valves heard loudest on expiration
murmurs from right-sided valves heard loudest on inspiration

Question 25

Clinical features of mitral stenosis

Answer 25

low volume pulse, may be irregularly irregular (AF common in mitral stenosis)
loud first heart sound with tapping apex beat
malar flush

Question 26

Mitral valve prolapse murmur name

Answer 26

combination of mid-systolic click and mid-late systolic murmur

Question 27

Tricuspid regurgitation murmur name

Answer 27

pansystolic murmur
loudest over tricuspid region

Question 28

Causes of tricuspid regurgitation

Answer 28

right ventricular dilatation (eg. secondary to pulmonary stenosis or pulmonary hypertension)
rheumatic fever
infective endocarditis (esp. IVDU)
carcinoid syndrome
congenital (eg. atrial septal defect, Ebstein anomaly)

Question 29

Clinical features of tricuspid regurgitation

Answer 29

large ‘v-waves’ visible in jugular veins
visible/palpable hepatic pulsations
signs of right-sided heart failure (right ventricular heave, peripheral oedema, hepatomegaly, ascites)

Question 30

Pulmonary stenosis murmur name and features

Answer 30

ejection systolic murmur
loudest over pulmonary area
loudest during inspiration
radiates to left shoulder/left infraclavicular region

Question 31

Pulmonary stenosis causes

Answer 31

congenital (Turner’s, Noonan’s and William’s syndromes, tetralogy of fallot)
rheumatic fever
carcinoid syndrome

Question 32

Clinical features of pulmonary stenosis

Answer 32

prominent ‘a-waves’ in jugular veins
widely split S2
P2 may be soft and inaudible
right ventricular dilatation can cause right ventricular heave, tricuspid regurgitation and peripheral signs of right-sided heart failure

Question 33

Pulmonary regurgitation murmur

Answer 33

rare
early decrescendo murmur
loudest over left sternal edge
usually due to pulmonary hypertension
often asymptomatic

Question 34

Causes of pulmonary regurgitation

Answer 34

pulmonary hypertension
infective endocarditis
congenital valvular heart disease

Question 35

Tricuspid stenosis murmur name

Answer 35

soft diastolic murmur
loudest 3rd-4th intercostal space, left sternal edge
loudest on inspiration

Question 36

Causes of tricuspid stenosis

Answer 36

rheumatic fever
congenital disease
infective endocarditis

Question 37

Clinical features of tricuspid stenosis

Answer 37

raised JVP with giant ‘a-waves’
peripheral oedema
ascites