Murmurs

Question 1

What does the first heart sound signify

Answer 1

Closure of mitral and tricuspid valves

Question 2

What does the second heart sound signify

Answer 2

Closure of aortic and pulmonary valves

Question 3

What is a split S2 sound

Answer 3

Pulmonary valve may close just after the aortic, which is prolonged during inspiration, or in defects which cause more blood to be pumped out the RV

Question 4

Cause of aortic stenosis

Answer 4

Calcification of aortic valves. Congenital abnormality of aortic valve. Rheumatic heart disease

Question 5

Cause of mitral regurgitation

Answer 5

Infective endocarditis, acute MI with rupture of papillary muscles, rheumatic heart disease, congenital defects of mitral valve, cardiomyopathy

Question 6

Valvular causes of aortic regurgitation

Answer 6

Congenital bicuspid aortic valve, rheumatic heart disease, infective endocarditis

Question 7

Aortic root dilation causes, resulting in aortic regurgitation

Answer 7

Aortic dissection, connective tissue diseases, aortitis

Question 8

Pulse features of aortic stenosis

Answer 8

slow rising pulse, narrow pulse pressure

Question 9

S2 in aortic stenosis

Answer 9

Reduced or absent S2, reverse splitting of S2

Question 10

Apex beat features of mitral regurgitation

Answer 10

Displaced, hyperdynamic

Question 11

Apex beat features of aortic stenosis

Answer 11

Non-displaced, heaving

Question 12

Pulse of aortic regurgitation

Answer 12

Collapsing pulse (‘water hammer pulse’ with wide pulse pressure)

Question 13

Apex beat in aortic regurgitation

Answer 13

Displaced hyperdynamic

Question 14

Causes of mitral stenosis

Answer 14

Rheumatic disease (most common), congenital, left atrial myxoma, connective tissue disorders and mucopolysachharideosis

Question 15

Pulse pressures of mitral stenosis

Answer 15

Low volume pulse which may be irregularly regular (AF)

Question 16

Clinical features of mitral stenosis

Answer 16

Loud first heart sound with tapping apex beat and malar flush

Question 17

Type of murmur in aortic stenosis

Answer 17

Ejection systolic

Question 18

When is aortic stenosis murmur heard loudest

Answer 18

Loudest on expiration sitting forward

Question 19

Where do aortic stenosis murmurs radiate to

Answer 19

Carotid arteries

Question 20

Type of murmur in mitral regurgitation

Answer 20

Pansystolic murmur

Question 21

When is mitral regurgitation murmur heard loudest

Answer 21

Loudest using bell, on expiration in left lateral decubitus position

Question 22

Where do mitral regurgitation murmurs radiate to

Answer 22

Axilla

Question 23

Type of murmur heard in aortic regurgitation

Answer 23

Decrescendo early diastolic murmur

Question 24

Murmur heard in severe aortic regurgitation

Answer 24

Austin flint murmur - low pitched rumbling, mid-diastolic murmur head best at apex beat

Question 25

Where is aortic regurg murmur heard loudest

Answer 25

Left sternal edge and sometimes over aortic area

Question 26

Type of murmur heard in mitral stenosis

Answer 26

Low pitched rumbling mid-diastolic murmur with opening click

Question 27

When is mitral stenosis murmur heard loudest

Answer 27

Left lateral decubitus position on expiration

Question 28

Cause of tricuspid regurgitation

Answer 28

RV dilation, rheumatic fever, infective endocarditis, carcinoid syndrome, congenital causes

Question 29

Causes of pulmonary stenosis

Answer 29

Turner's, William's, Noonan's syndrome, tetrology of fallot, rheumatic fever, carcinoid syndrome

Question 30

Causes of pulmonary regurgitation

Answer 30

Pulmonary HTN, infective endocarditis, congenital valvular heart disease

Question 31

Causes of tricuspid stenosis

Answer 31

Rheumatic fever, congenital disease, infective endocarditis

Question 32

Type of murmur in tricuspid regurgitation

Answer 32

Pansystolic murmur

Question 33

Type of murmur in pulmonary stenosis

Answer 33

Ejection systolic murmur

Question 34

When is tricuspid regurgitation heard loudest

Answer 34

During inspiration

Question 35

When and where is pulmonary stenosis heard loudest

Answer 35

During inspiration, radiating to left shoulder and infraclavicular region

Question 36

Type of murmur in pulmonary regurgitation

Answer 36

Early diastolic murmur

Question 37

When is pulmonary regurgitation murmur heard loudest

Answer 37

During inspiration at left sternal edge

Question 38

Type of murmur in tricuspid stenosis

Answer 38

Mid-diastolic murmur

Question 39

When and where is tricuspid stenosis heard loudest

Answer 39

During inspiration at left sternal edge 3rd-4th intercostal region

Question 40

Clinical features associated with tricuspid regurgitation

Answer 40

Large V waves in jugular veins, visible/palpable hepatic pulsations, signs of right sided heart failure

Question 41

Clinical features of pulmonary regurgitation

Answer 41

Usually asymptomatic

Question 42

Clinical features of tricuspid stenosis

Answer 42

Raised JVP with giant A waves and peripheral oedema or ascites

Question 43

Clinical features of pulmonary stenosis

Answer 43

Prominent A waves in jugular veins, widely split S2, P2 may be soft and inaudible, signs of right sided heart failure

Question 44

Triad of symptoms associated with aortic stenosis

Answer 44

Heart failure, syncope and angina

Question 45

Diagnosis and grading of aortic stenosis

Answer 45

Echo

Question 46

Which valvular heart diseases cause left hypertrophy

Answer 46

Mitral stenosis and aortic stenosis

Question 47

Which valvular heart diseases cause left dilatation

Answer 47

Mitral and aortic regurgitation