Murmur and Valvular Heart Disease

Question 1

Where do you listen for the 4 valves during a Cardio examination?

Answer 1

• 2nd ICS right sternal edge - Aortic
• 2nd ICS left sternal edge- Pulmonary
• 4th ICS lower left sternal edge - Tricuspid
• 5th ICS (apex) mid-clavicular line - Mitral

Question 2

What does a continuous murmur suggest?

Answer 2

Patent ductus arteriosus

Question 3

What would a mid-diastolic murmur suggest?

Answer 3

Mitral Stenosis - low pitch rumbling

Question 4

What would a pansystolic murmur suggest?

Answer 4

Mitral Regurgitation

Question 5

What would an ejection systolic murmur suggest?

Answer 5

Aortic Stenosis - crescendo decrescendo murmur

Question 6

What would an early diastolic murmur suggest?

Answer 6

Aortic regurgitation (soft blowing murmur)

Question 7

What is Mitral stenosis associated with

Answer 7

History of Rheumatic heart disease (20 years ago)

Question 8

Symptoms/signs of MS

Answer 8

Dyspnoea
Orthopnea/PND
Haemoptosis (rare)
AF

Question 9

What would an ECG show for MS?

Answer 9

↑ Right ventricle (V1, V2, V3; QRS complex enlarged)
↑ Left Atrium (V1, V2, V3; enlarged biphasic P wave)
OR AF

Question 10

What would CXR show for MS?

Answer 10

Double bubble (Double density)

Pulmonary oedema

Question 11

How would you examine/listen for MS?

Answer 11

With the patient rolled on their left side

Listening with the bell at the apex beat area