murmurs

Question 1

what takes place after the first heart sound?

Answer 1

systole

Question 2

what takes place after the second heart sound?

Answer 2

diastole

Question 3

what investigation diagnosis murmurs?

Answer 3

ECHO

Question 4

what causes aortic stenosis?

Answer 4

congenital bicuspid valve (2 leaflets instead of 3) (seen in <65)
rheumatic heart disease
age related calcification and degeneration >65

Question 5

what symptoms would be seen in aortic stenosis?

Answer 5

SOB
chest pain
dizziness and blackouts

Question 6

what sign is seen with aortic stenosis?

Answer 6

ejection systolic murmur heard in the aortic region and radiates to the carotids

Question 7

what additional signs are seen with aortic stenosis?

Answer 7

slow rising pulse
narrow pulse pressure
splitting of second heart sound 
crescendo and decrescendo in nature 
S4 (indicative of LVH)
soft/absent S2

Question 8

what complications can aortic stenosis cause?

Answer 8

angina
syncope
heart failure

Question 9

what is the management for aortic stenosis?

Answer 9

surgery - valve replacement
TAVI - trans aortic valve implantation
(surgery needed as poor prognosis due to progressive heart failure)

Question 10

what causes mitral regurgitation?

Answer 10

left ventricular dilation
degenerative rupture of cadre tendinae
endocarditis

Question 11

what symptoms are seen with mitral regurgitation?

Answer 11

SOB
fatigue
peripheral oedema

Question 12

what sign is seen with mitral regurgitation?

Answer 12

pan systolic murmur best heard at the apex beat and radiates to the axilla

Question 13

what additional signs are seen with mitral regurgitation?

Answer 13

displaced apex

splitting of second heart sound

Question 14

what is the management of mitral regurgitation?

Answer 14

heart failure control - ACEi, BB, spironolactone

surgery intervention in severe - repair rather than replace

Question 15

what causes aortic regurgitation?

Answer 15

acute - endocarditis, aortic dissection

Marfans

Question 16

what symptoms are seen with aortic regurgitation?

Answer 16

SOB, orthopnea
chest pain
dizziness

Question 17

what sign is seen with aortic regurgitation?

Answer 17

early diastolic murmur best heard when patient is sitting forward and expiring

Question 18

what additional signs are seen with aortic regurgitation?

Answer 18

displaced apex
collapsing pulse
De Muessets sign - head nodding with each beat
Quincke’s sign - pulsation in capillary nail beds
wide pulse pressure

Question 19

what are complications of aortic regurgitation?

Answer 19

heart failure

LV hypertrophy

Question 20

what is the management of aortic regurgitation?

Answer 20

control hypertension - ACEi

surgery valve replacement - when LVH/HF progresses

Question 21

what causes mitral stenosis?

Answer 21

rheumatic heart disease

Question 22

what symptoms are seen with mitral stenosis?

Answer 22

SOB
fatigue
palpitations - AF

Question 23

what sign is seen with mitral stenosis?

Answer 23

rumbling mid-late diastolic murmur best heard with patient lying on side and expiring

Question 24

what additional signs are seen with mitral stenosis?

Answer 24

malar rash
opening snap on S1
AF

Question 25

what it the management for mitral stenosis?

Answer 25

SOB - ACEi/diuretic
AF - rate control and anti-coagulation
surgical - valloon valvuloplasty/valve replacement

Question 26

what is the sign of patent ductus arteriosus?

Answer 26

constant machine like murmur