Differentials Murmur

Question 1

Ejection systolic murmur

= left or right ventricular outflow tract obstruction

Answer 1

Systolic Murmur LLSE = VSD

ESM ULSE/URSE

• Aortic stenosis (click if valvular, radiates carotids)
• Pulmonary stenosis
• Coarctation (radiates back)
• HOCM (increases with valsava)

Question 2

Diastolic murmur

Answer 2

Early diastolic = aortic or pulmonary regurgitation/incompetence
Late diastolic = mitral or tricuspid stenosis

AR/PR can be heard post TOF repair

Question 3

Continous murmur

Answer 3

PDA
Arteriovenous fistula
Venous hum
MAPCA (major aortopulmonary collateral arteries)

Question 4

Pansystolic murmur
= murmus heard below nipple line
= acyanotic

Answer 4

VSD (can be isolated VSD or VSD associated TGA or truncus arteriosus)
Ebstein
Mitral/tricuspid regurgitation

LLSE - VSD, AVSD, HOCM, TOF

Question 5

Innocent murmur

e.g. Stills murmur

Answer 5

Systolic
Get softer when sit upright
Gets louder with exercise

Question 6

ECG

Answer 6

PS = RAD, RVH 
AS = LVH 
VSD = LVH 
Hypoplastic left heart = RVH
Tricuspid atresia = LAD, superior QRS 
Ebstein = WPW, RBBB
Bazette formula QTc

Question 7

CXR

Answer 7

TGA = Egg on a string 
TOF = boot shaped 
AVSD = goose neck deformity
Ebstein = extreme cardiomegaly 
TAPVR = snowman 
Coarctation = rib notching / figure of 3