Heart Murmurs

Question 1

Pansystolic ‘blowing’ murmur heard best at the apex and radiating into the axilla

Answer 1

Mitral regurgitation

Question 2

Pan-systolic murmur + left parasternal heave + giant V waves in JVP

Answer 2

Tricuspid regurgitation

Question 3

Causes of midsystolic murmurs (6)

Answer 3

1. Benign (innocent) murmurs
2. Increased flow rate across a normal semilunar valve
3. Aortic valve sclerosis
4. Aortic outflow obstruction
5. Pulmonic outflow obstruction
6. Dilation of the artic root or pulmonary artery

Question 4

Early systolic murmurs

Answer 4

• mitral regurgitation
• tricuspid regurgitation
• ventricular septal defect

Question 5

Late systolic murmurs

Answer 5

1. Mitral valve prolapse
2. Tricuspid valve prolapse
3. Ischaemic mitral regurgitation

Question 6

Early diastolic murmur + collapsing pulse + wide pulse pressure

Answer 6

Aortic regurgitation

Question 7

2 visual signs of aortic regurgitation

Answer 7

1. Quincke’s sign (nailed pulsation)
2. De Musset’s sign (head bobbing)

Question 8

Early diastolic murmurs

Answer 8

1. Aortic regurgitation
2. Pulmonary regurgitation
3. Left anterior descending artery stenosis

Question 9

Mid-late diastolic murmur (best heard in expiration)
Loud S1, opening snap
Malar flush

Answer 9

Mitral stenosis

Question 10

Mid-diastolic murmurs (6)

Answer 10

1. Mitral stenosis
2. Tricuspid stenosis
3. Atrial myxoma
4. Increased flow across the AV valve
5. Austin-flint murmur
6. Left to right shunts

Question 11

Murmur of left to right shunt

Answer 11

Mid-diastolic murmur

Question 12

Late diastolic (presystolic) murmurs

Answer 12

1. Mitral stenosis
2. Triscuspid stenosis
3. Myxoma
4. Complete AV block