Murmurs and valvular pathology

Question 1

Aortic area

Answer 1

• 2nd ICS
• Right sternal border

Question 2

Pulmonary area

Answer 2

• 2nd ICS
• Left sternal border

Question 3

Erb’s point

Answer 3

• 3rd ICS
• Left sternal border

Question 4

Tricuspid area

Answer 4

• 5th ICS
• Left sternal border

Question 5

Mitral area

Answer 5

• 5th ICS space
• Midclavicular line

Question 6

what valvular pathology cause left atrial hypertrophy and why

Answer 6

• Mitral stenosis
• Pushing against a stenosed valve is what cause hypertrophy

Question 7

What valvular pathology causes LV hypertrophy

Answer 7

Aortic stenosis

Question 8

what valular pathology would cause LA dilation and why ?

Answer 8

Mitral regurgitation : a leaky valve allows blood to flow back into a chamber causing it too thin and dilate

Question 9

What valular pathology would cause LV dilatation

Answer 9

Aortic regurgitation

Question 10

Describe the murmur heard in AS

Answer 10

• Ejection systolic
• High pitched
• Crescendo descendo
• Heard loudest in the aortic area

Question 11

3 causes of AS

Answer 11

1. Idiopathic age related calcification (most common) >65yrs
2. Rheumatic disease
3. Bicuspid aortic valve <65 ys

Question 12

Radiation of murmur in AS

Answer 12

Carotids

Question 13

3 other signs of AS

Answer 13

• Slow rising pulse
• Narrow pulse pressure
• Soft / absent S2
• S4

Question 14

3 signs of severe AS

Answer 14

S : syncope (exertional)
A : angina
D : dyspnoea

Question 15

Treatment of severe AS in pts high risk for open aortic valve replacement

Answer 15

Transcatheter aortic valve implantation

Question 16

why can the apex be displaced in AS?

Answer 16

Due to LV hypertrophy caused by trying to push blood against a stenosed valve

Question 17

what 3 Ix would you do in AS and why ?

Answer 17

1. Echo - diagnostic
2. ECG - LV hypertophy
3. CXR - cardiomegaly

Question 18

when is valvular replacement consider for AS

Answer 18

1. Symptomatic
2. Asymptomatic but with valvular gradient >40mmHg and with features such as LV systolic dysfunction

Question 19

Murmur heard in aortic regurgitation and how is the intensity of the murmur increased

Answer 19

Early diastolic murmur
Handgrip manoeuvre

Question 20

2 other features of aortic regurgitation

Answer 20

Collapsing pulse
wide pulse pressure

Question 21

2 signs elicited in aortic regurgitation

Answer 21

1. Quincke’s sign (nailbed pulsation).
2. De Musset’s sign (head bobbing)

Question 22

Further murmur heard in aortic regurgitation and why

Answer 22

Mid diastolic austin flint murmur if severe -> vibrating of mitral valve as blood flows back over it

Question 23

Causes of AR due to valve disease and common acute presentation

Answer 23

1. Rheumatic fever
2. Calcific disease
3. Connective tissue disease (RA/SLE)

Infective endocarditits

Question 24

Murmur heard in mitral stenosis

Answer 24

Mid-late diastolic murmur
Best heard on inspiration

Question 25

Other features heard in mitral stenosis

Answer 25

- Loud S1 - Opening snap : indicates valve leaflets are still mobile

Question 26

Symptoms seen in mitral stenosis

Answer 26

SOB Haemoptysis Malar flush

Question 27

Findings on CXR in MS

Answer 27

LA enlargement

Question 28

Likely underlying valve disease if AF and mid-late diastolic murmur

Answer 28

Mitral stenosis

Question 29

Most common cause of mitral stenosis

Answer 29

Rheumatic fever

Question 30

Describe the murmur heard in Mr

Answer 30

Blowing pansystolic murmu Heard best at the apex Radiates to the axilla

Question 31

what may be seen on ECG in MR

Answer 31

Broad P wave, indicative of atrial enlargement

Question 32

What may be seen on CXR in MR

Answer 32

Cardiomegaly due to LA enlargment

Question 33

Ejection systolic murmur

Answer 33

- AS - Hypertrophic obstructive cardiomyopathy - Pulmonary stenosis - ASD - TOF

Question 34

Pansystolic murmur

Answer 34

- Mitral regurg - Tricuspid regurg - VSD

Question 35

Early diastolic

Answer 35

Aortic regurg (high pitched and blowing)

Question 36

Mid - late diastolic

Answer 36

Mitral stenosis (rumbling)

Question 37

Continuous machinery like

Answer 37

PDA

Question 38

Ejection systolic louder on expiration

Answer 38

Aortic stenosis or hypertrophic obstructive cardiomyopathy

Question 39

Ejection systolic louder on inspiration

Answer 39

Pulmonary stenosis ASD

Question 40

Pansystolic, louder on inspiration

Answer 40

Tricuspid regurgitation