Cardiac murmurs

Question 1

Three types of benign murmurs

Answer 1

1. still’s murmur: low pitched sound at lower left sternal edge
2. venous hum: continuous blowing noise below clavicles (due to turbulent flow of blood in great veins)
3. ejection murmur: 5Ss. due to turbulent flow in outflow tract from heart

Question 2

Tetralogy of fallot

Answer 2

Ejection systolic murmur (loud, harsh) at left sternal edge due to pulmonary stenosis

*as RV outflow tract obstruction increases, the murmur will shorten, and cyanosis will increase

Question 3

TGA

Answer 3

Usually no murmur (may have a systolic murmur from increased flow or stenosis within the left ventricular outflow tract)

2nd HS often loud and single

Question 4

Small VSD

Answer 4

• Loud pansystolic murmur
  
  • at the LOWER left sternal edge
  • loud murmur implies a smaller defect
• Quiet pulmonary second sound (P2)

Question 5

Large VSD

Answer 5

• Hyperdynamic precordium
• Soft pansystolic murmur or NO murmur (implying large defect)
  
  • Pan-systolic murmur more prominently heard at the left lower sternal boarder in the third and fourth intercostal spaces.
• There may be a systolic thrill on palpation.
• Apical mid-diastolic murmur (from increased blood flow across mitral valve)
• Loud pulmonary second sound (P2)- from raised pulmonary artery pressure

Question 6

AVSD

Answer 6

No murmur

Question 7

PDA

Answer 7

• Continuous machinery murmur below the left clavicle:
• left subclavicular thrill
• Wide pulse pressure
• large volume, bounding, collapsing pulse
• heaving apex beat

Question 8

Aortic coarctation

Answer 8

Systolic murmur

• L infraclavicular
• and below L scapula

Question 9

Aortic stenosis

Answer 9

• *Ejection systolic murmur**
  
  • maximal at the upper RIGHT sternal edge
  • and radiating to carotids

Question 10

Ebstein’s anomaly

Answer 10

• tricuspid regurgitation:
  
  • pansystolic murmur, worse on inspiration
• and tricuspid stenosis:
  
  • mid-diastolic murmur