Heart Murmurs

Question 1

how can you describe a heart murmur

Answer 1

S - site
C - character: soft, blowing, crescendo, decrescendo
R - radiation: carotids (AS), axilla (MR)
I - intensity: grade
P - Pitch: high/ low indicated the velocity of the murmur
T - timing: diastolic or systolic

Question 2

what can cause mitral stenosis

Answer 2

rheumatic heart disease and infective endocarditis

Question 3

what might you see on examination of a patient with heart murmurs

Answer 3

Malar flush
Pulse: tachycardia and irregular due to AF, volume and character normal
JVP may be raised if severe
Tapping apex beat
Right ventricular heave

Question 4

describe what could be heard on auscultation of a patient with mitral stenosis

Answer 4

Mid- diastolic
Low pitch, rumbling murmur
Heard over the mitral area and exaggerated by rolling the patient towards the left

Question 5

what arrythmia can develop in patients with mitral stenosis

Answer 5

AF can develop in association due to LA strain

Question 6

what can cause mitral regurgitation

Answer 6

Idiopathic weakening with age. Associated with IHD, RHD, IE, and connective tissue disorders

Question 7

what can you find on examination of patients with mitral regurgitation

Answer 7

Patient appears normal on inspection.
Pulse, HR, BP and JVP normal
Apex beat is displaced and hyperdynamic
Can sometimes rarely hear a thrill at the apex

Question 8

what can you hear on auscultation with mitral stenosis

Answer 8

Pan systolic murmur
High pitched murmur which radiates to the axilla

Question 9

what can cause aortic stenosis

Answer 9

Idiopathic age related calcification, or less commonly rheumatic heart disease

Question 10

what can you find on examination of patients with aortic stenosis

Answer 10

Pale and sweaty on inspection
Tachycardic, and low volume pulse.
Slow rising pulse
Narrow pulse pressure
Normal JVP
Non displaced pressure loaded apex beat

Question 11

what can you hear on auscultation for aortic stenosis

Answer 11

Ejection crescendo-decrescendo systolic murmur
High pitched (pitch gets higher the more severe it is)
Murmur can radiate to the carotids

Question 12

what is exertional syncope suggestive of

Answer 12

aortic stenosis
difficult to maintain good blood flow to the brain

Question 13

what can cause aortic regurgitation

Answer 13

Idiopathic age related weakness, connective tissue disorders

Question 14

what are three signs you may see in patients with aortic regurgitation

Answer 14

Corrigan’s sign (pulsatile between 2 clavicular heads)
De Musset’s sign (nodding of the head involuntarily when relaxed)
Quinkes sign (repetitive and pulsatile flushing of the nail beds)

Question 15

what could you find on examination of a patient with aortic regurgitation

Answer 15

Bradycardic
High pulse pressure
Wide and collapsing pulse
Normal JVP
Displaced apex beat which is hyperdynamic / volume loaded

Question 16

what can you hear on auscultation of aortic regurgitation

Answer 16

Early decrescendo diastolic soft murmur
Longer murmur indicated moderate MR (not severe)

Question 17

what sign may you see in patients with tricuspid regurgitation

Answer 17

Raised JVP: elephant ears/ V waves
RV heave
may have signs of respiratory disease as often secondary to this

Question 18

what murmur can be heard in tricuspid regurgitation

Answer 18

pan systolic high pitched murmur
Is a functional murmur

Question 19

describe findings which would suggest a small VSD

Answer 19

Tapping thrill at lower left sternal edge

Very loud, Pansystolic murmur