Murmurs

Question 1

What are the 3 common signs of right heart failure?

Answer 1

1) Raised JVP
2) Pitting Oedema (ankle and sacral)
3) Hepatic congestion

Question 2

What are the 2 diastolic murmurs?

Answer 2

ARMS:

1) Aortic regurgitation
2) Mitral stenosis

Question 3

Where does aortic stenosis tend to radiate to?

Answer 3

The carotids

Question 4

Where does mitral regurgitation tend to radiate to?

Answer 4

The axilla

Question 5

What are the 3 common causes of aortic stenosis?

What are the symptoms of aortic stenosis?

Answer 5

• Degenerative (age related)
• A congenital bicuspid valve
• Rheumatic heart disease
• Breathlessness
• Syncope/dizziness
• Chest pain

Question 6

What are the clinical signs of aortic stenosis?

Answer 6

• Low volume pulse
• Forceful displaced apex
• Ejection systolic murmur that radiates to the carotids.
• Splitting of the 2nd heart sound.

Treatment = Valve replacement (preferred)

Question 7

Name some of the causes of mitral regurgitation?

Answer 7

• Left ventricular dilatation
• Papillary muscle rupture due to ischaemia
• Degenerative rupture of chordae tendinae.

Question 8

Symptoms and signs of mitral regurgitation?

Answer 8

• Breathlessness
• Peripheral oedema
• Fatigue
• Palpitations: AF

Pan systolic murmur best heard at the axilla.

• Displaced apex
• Splitting of 2nd heart sound
• CXR may show cardiomegaly.

Question 9

Management of mitral regurgitation?

Answer 9

Surgical intervention in progressing disease.

• Repair if prolapsed
• Replace if degenerative

Diuretics and ACEI if heart failure.

Question 10

Causes and symptoms of mitral stenosis?

Answer 10

Congenital or rheumatic heart disease.

Breathlessness, fatigue, palipitations (AF).

Question 11

Signs of mitral stenosis?

Answer 11

• Malar flush
• Tapping apex beat
• Mid diastolic rumbling murmur, best heard on expiration with patient lying on their side
• Opening snap on S1

Treatment = Valve replacement.

Question 12

Causes of aortic regurgitation?

Answer 12

Acute: endocarditis, aortic dissection

Chronic: Marfan’s, seronegative arthritis, vasculitis.

Symptoms: Breathlessness

Question 13

Signs of aortic regurgitation?

Answer 13

Early diastolic murmur best heard at the left sternal edge when the patient is sitting forward and expiring.

• Displaced apex.
• Collapsing pulse
• Wide pulse pressure.