Murmurs

Question 1

ejection systolic murmur, ‘crescendo-decrescendo’ quality, loudest at aortic area, radiates to carotids

Answer 1

Aortic stenosis
caused by calcification, congenital bicuspid valve, rheumatic heart disease

Question 2

pansystolic murmur, loudest at mitral area, radiates to axilla

Answer 2

Mitral regurgitation
caused by infective endocarditis, myocardial infarction, rheumatic heart disease, congenital defects, cardiomyopathy

Question 3

early diastolic murmur, Decrescendo,loudest at left sternal edge

Answer 3

Aortic regurgitation
caused by :

Diseases affecting the valve include:

Congenital bicuspid aortic valve
Rheumatic heart disease
Infective endocarditis
Causes of aortic root dilatation include:

Aortic dissection: can result in acute aortic regurgitation
Connective tissue diseases (e.g. Marfan’s syndrome)
Aortitis

features include collapsing pulse

Question 4

mid-diastolic murmur, loudest at apex

Answer 4

Mitral stenosis
caused by rheumatic heart disease, congenital defects, myxoma, connective tissue disorders;

A low-volume pulse which may be irregularly, irregular (atrial fibrillation is common in mitral stenosis)
Loud first heart sound with tapping apex beat (due to a palpable closing of the mitral valve)
A malar flush (plum-red discolouration of the cheeks)

Question 5

mid-systolic click and mid to late-systolic murmur, loudest at apex

Answer 5

Mitral valve prolapse
associated with connective tissue diseases; features include mid-systolic click followed by murmu

Question 6

pansystolic murmur, loudest at tricuspid area

Answer 6

Tricuspid regurgitation
caused by right ventricular dilatation, rheumatic fever, infective endocarditis, carcinoid syndrome, congenital defects;

features include large ‘v-waves’ in JVP, hepatic pulsations, signs of right-sided heart failure.

Question 7

ejection systolic murmur, loudest at pulmonary area, radiates to left shoulder

Answer 7

Pulmonary stenosis
congenital syndromes, rheumatic fever, carcinoid syndrome

Question 8

early diastolic murmur, loudest at left sternal edge, loudest on inspiration;

Answer 8

Pulmonary regurgitation
caused by pulmonary hypertension, infective endocarditis, congenital heart disease.

Question 9

mid-diastolic murmur, loudest at left sternal edge, loudest on inspiration

Answer 9

Tricuspid stenosis
caused by rheumatic fever, congenital disease, infective endocarditis;
features include raised JVP, peripheral oedema, ascites.

Question 10

first heart sound (S1)

Answer 10

closure of the mitral and tricuspid valves. It marks the start of ventricular systole, and a peripheral pulse is felt at the same time (or shortly after) S1.

Question 11

second heart sound (S2)

Answer 11

closure of aortic and pulmonary valves. It marks the end of ventricular systole and the start of diastole.

pulmonary valve may close just after the aortic valve.

Closure of the pulmonary valve just after the aortic valve is prolonged during inspiration, or in defects which cause more blood to be pumped out of the right ventricle.

Therefore, S2 may not always be heard as one (split S2).

Question 12

Levine scale for grading cardiac murmurs according to intensity

Answer 12

One-Very faint. Heard by an expert in optimum conditions

Two -Heard by a non-expert in optimum conditions

Three-Easily audible, no thrill

Four-A loud murmur, with a thrill

Five-Very loud, often heard over a wide area, with thrill

Six-Extremely loud, heard without a stethoscope

Question 13

S3 causes

Answer 13

(DILATED VENTRICLE)
systolic HF
Dilated cardiomyopathy
young athletes

Question 14

S4 causes

Answer 14

rigid ventricle
-diastolic HF
causes of LVH:
-aortic stenosis
-chronic HTN

Question 15

ASD

Answer 15

soft systolic ejection murmur AT PULMONARY AREA

Question 16

VSD

Answer 16

left sternal edge PANSYSTOLIC

Question 17

prosthetic aortic valve

Answer 17

systolic ejection murmurs