Cardio week: Murmurs

Question 1

What does S1 represent

Answer 1

Closing of mitral and tricuspid valves

Question 2

What does S2 represent

Answer 2

Closing of aortic and pulmonary valves

Question 3

What 3 types of systolic murmur are there

Answer 3

1. Ejection systolic
2. Pan systolic
3. Late systolic

Question 4

What 2 types of diastolic murmur are there

Answer 4

1. Early diastolic

2. Mid diastolic

Question 5

What causes S3

Answer 5

Blood oscillating in ventricle due to rapid filling

Question 6

What causes S4

Answer 6

Blood forced into stiff ventricle

Question 7

What cardiac condition is S3 associated with

Answer 7

Heart failure

Question 8

What might cause a systolic murmur

Answer 8

1. Aortic stenosis
2. Mitral regurgitation
3. Mitral valve prolapse

Question 9

What might cause a diastolic murmur

Answer 9

1. Aortic regurgitation

2. Mitral stenosis

Question 10

What kind of murmurs may hypertrophic cardiomyopathy cause

Answer 10

Aortic stenosis

Mitral regurgitation

Question 11

3 types of pathology of aortic stenosis

Answer 11

1. Age related calcification
2. Bicuspid aortic valve
3. Rheumatic heart disease

Question 12

Clinical features of aortic stenosis

Answer 12

• Auscultation: ESM over carotids
• Slow rising carotid pulse
• Angina
• Exertional dyspnoea
• Previous syncope

Question 13

Name some causes of mitral regurgitation

Answer 13

• Functional MR in LV dilation
• Degenerative mitral valve disease
• Infective endocarditis
• Hypertrophic cardiomyopathy
• Floppy valve
• Ruptured chordae tendinae or papillary muscle
• SLE, Marfans, Ehlers-Danlos (rare)

Question 14

Clinical features of mitral regurgitation

Answer 14

• Auscultation: Pansystolic murmur at apex radiating towards axilla
• Laterally displaced apex beat

Question 15

Acute causes of aortic regurgitation

Answer 15

• Infective endocarditis
• Acute rheumatic fever
• Aortic dissection
• Connective tissue disorders

Question 16

Chronic causes of aortic regurgitation

Answer 16

• Congenital bicuspid aortic valve
• Chronic rheumatic fever
• Arthritis (RA, ankylosing spondylitis)
• Severe hypertension
• Marfan’s

Question 17

Clinical features of aortic regurgitation

Answer 17

• Auscultation: EDM over LLSE
• Most pts asymptomatic as AR well tolerated
• Collapsing pulse

Question 18

Main cause of mitral stenosis

Answer 18

Rheumatic fever

Question 19

Clinical features of mitral stenosis

Answer 19

• Auscultation: Rumbling mid diastolic murmur at apex

- Malar flush

Question 20

What do syncope, angina, dypnoea indicate

Answer 20

Aortic stenosis

Question 21

What might cause a continuous murmur

Answer 21

Patent ductus arteriosus

heard at upper LSE, radiates over left scapula