Heart Murmurs and Pulses

Question 1

Systolic Murmurs

Answer 1

Aortic Stenosis

Mitral Regurgitation

Question 2

Diastolic Murmurs

Answer 2

Aortic Regurgitation

Mitral Stenosis

Question 3

Slow rising pulse

Answer 3

Aortic Stenosis

Question 4

High volume collapsing pulse

Answer 4

Aortic Regurgitation

Patent Ductus Arteriosus

Question 5

Causes of Aortic Regurgitation

Answer 5

Aortic valve abnormality

Dilation of the proximal ascending aorta

Question 6

Harsh pan-systolic murmur
Loudest at left lower sternal edge and inaudible at the apex
Non displaced apex
Does not intensify on inspiration

Answer 6

Ventricular Septal Defect

Question 7

Soft late systolic murmur

At the apex, radiation to the axilla

Answer 7

Mitral Valve Prolapse

Question 8

Slow rising pulse 
Non displaced, heaving apex
Ejection systolic murmur 
Heard at right second intercostal space
No radiation

Answer 8

Aortic Stenosis

Question 9

Regular, jerky pulse
Cardiac impulse is hyper dynamic and not displaced
Mid systolic murmur, with no ejection click
Loudest at left sternal edge

Answer 9

Hypertrophic Cardiomyopathy

Question 10

Constant “machinery like” murmur throughout systole and diastole

Answer 10

Patent Ductus Arteriosus

Question 11

Causes of Mitral Stenosis

Answer 11

Rheumatic fever 
Congenital causes
Malignant causes 
Systemic lupus erythematosus (SLE)
Left atrial myxoma

Question 12

Clinical Features of Mitral Stenosis

Answer 12

Palpitations
Dyspnoea
Haemoptysis

Question 13

What pulse would be felt in cardiac tamponade?

Answer 13

Paradoxical

abnormally large decrease in SBP and pulse wave amplitude during inspiration

Question 14

In what conditions might you feel a paradoxical pulse?

Answer 14

Left ventricular compression
Constrictive pericarditis
Severe asthma

Question 15

What pulse would you feel in severe left ventricular failure?

Answer 15

Alternans (Alternating pulse)

Regular rhythm, alternating beats which are weak then strong

Question 16

What is Takayasu’s arteritis?

Answer 16

Idiopathic arteritis

Typically causes narrowing of major arteries

Question 17

What pulses/murmurs might be heard in Takayasu’s arteritis?

Answer 17

Absent pulses
Aortic regurgitation
Systolic murmurs above and below clavicle

Question 18

In aortic stenosis, which symptom would confer the worst prognosis?

Answer 18

Syncope

Question 19

Pan systolic murmur

Soft S1, Split S2

Answer 19

Mitral Regurgitation

Question 20

Narrow pulse pressure

Answer 20

Aortic stenosis

Question 21

Mid-late diastolic murmur (best heard on expiration
Loud S1, opening snap
Low volume snap
Malar flush 
Atrial fibrillation

Answer 21

Mitral stenosis

Question 22

What causes an S4?

Answer 22

Ventricular hypertrophy:
Aortic Stenosis
Long standing hypertension
Hypertrophic cardiomyopathy
Atrial contraction against a stiff ventricle

Question 23

What causes an S3?

Answer 23

Diastolic filling of the ventricle

Considered normal if

Question 24

What are the most common primary coronary tumours, and what murmur might they cause?

Answer 24

Atrial myxoma

Left atrial myxoma = `Loud S1, Early diastolic plop