Cardio3

Question 1

What are your systolic murmurs?

Answer 1

Aortic stenosis
Mitral regurgitation
Tricuspid regurgitation

Question 2

What are your diastolic murmurs?

Answer 2

Aortic regurgitation
Mitral stenosis

ARMS- 2 of them aka di-astolic [di=2]

Question 3

What are the causes of systolic murmurs?

Answer 3

Age-related cacification (AS)
Congenital bi-cuspid aortic valve (AS)
Infective endocarditis (TR- think IVDU)
Rheumatic HD (Commonly MR)
Connective tissue disorders (Marfan, EDS, osteogenesis imperfecta)

Question 4

What is the epidemiology of systolic murmurs?

Answer 4

3% of 75 yr olds

M>F

Question 5

What are the symptoms of systolic murmurs?

Answer 5

Dyspnoea
Syncope on exertion
Angina
HF symptoms
Palpitations

Question 6

What are the signs of aortic stenosis?

Answer 6

Narrow pulse pressure
Slow rising pulse
Thrill

Question 7

What are the signs of mitral regurgitation?

Answer 7

Normal/irregularly irregular pulse

Laterally displaced apex beat

Question 8

What are the signs of tricuspid regurgitation?

Answer 8

Raised JVP
Parasternal heave
Signs of RHF
(pleural effusion, hepatomegaly, ascites, pitting oedema)

Question 9

Where does an aortic stenosis murmur radiate to?

Answer 9

The right carotid artery

Question 10

Where does a mitral murmur radiate to?

Answer 10

The left axilla

Question 11

What murmur is accentuated upon expiration and leaning forwards?

Answer 11

Aortic regurgitation

Question 12

What murmur is accentuated upon expiration and leaning to the left?

Answer 12

Mitral stenosis and regurgitation

Question 13

What murmurs are accentuated upon inspiration?

Answer 13

Tricuspid and pulmonary murmurs

Question 14

Which murmur would be present if a CXR showed aortic valve calcification?

Answer 14

Aortic stenosis

Question 15

Which murmur would be present if a CXR showed right sided enlargement?

Answer 15

Tricuspid regurgitation

Question 16

Which murmur would be present if a CXR showed cardiomegaly calcification?

Answer 16

Mitral regurgitation

Question 17

What can cause diastolic murmurs?

Answer 17

Infection (RhHD, IE)
Congenital (bicuspid aortic valve)
Aortic dilation (aortitis, HTN)
CTD

Question 18

Rheumatic heart disease characteristically causes which valvular defect?

Answer 18

Mitral stenosis

Question 19

What are the symptoms of AR/MS?

Answer 19

Dyspnoea
Syncope on exertion
Angina
HF signs
Palpitations
Orthopnoea

Question 20

What would you see on examination of a Pt with AR?

Answer 20

Wide pulse pressure
Water hammer pulse
Displaced apex beat

Question 21

What would you see on examination of a Pt with MS?

Answer 21

Malar flush
Thready/irregularly irregular pulse
Tapping apex, parasternal heave

Question 22

Which is the early diastolic and which is the mid diastolic murmur?

Answer 22

Early diastolic- aortic regurgitation

Mid diastolic- mitral stenosis

Question 23

A 49-year-old woman presents with increasing shortness of breath on exertion developing over the past three months. She has no chest pain or cough, and has noticed no ankle swelling. On examination, blood pressure is 158/61mmHg, pulse is regular at 88 beats per minute and there are crackles at both lung bases. There is a decrescendo diastolic murmur at the left sternal edge. What is the most likely diagnosis?

A. Aortic regurgitation
B. Aortic stenosis 
C. Mitral regurgitation 
D. Mitral stenosis 
E. Tricuspid regurgitation

Answer 23

A. Aortic regurgitation

Note the wide pulse pressure, the lung base crackles, and the decrescendo diastolic murmur on the LEFT sternal edge (AS is heard at the right sternal edge)

Question 24

You see a 57-year-old woman who presents with worsening shortness of breath coupled with decreased exercise tolerance. She had rheumatic fever in her adolescence and suffers from essential hypertension. On examination, she has a mid-diastolic murmur heard loudest over the mitral area. Which of the following is not a clinical sign associated with this particular diagnosis?

A. Malar flush 
B. Atrial fibrillation 
C. Pan-systolic murmur which radiates to axilla 
D. Tapping, un-displaced apex beat 
E. Right ventricular heave

Answer 24

C. Pan-systolic murmur which radiates to axilla

Note the Rheumatic heart disease, and murmur loud at the mitral area indicates mitral stenosis, which is a mid-diastolic murmur.

Question 25

An 8 year old boy comes to the GP with his mother for a check-up. You find the child to be extremely sociable and friendly, with some mild learning difficulties. You also note distinct facial features including broad forehead, short nose and full cheeks. On auscultation of his chest, you detect a murmur in the right 2nd intercostal space, loudest on expiration. What is the most likely diagnosis?

A. Hypertrophic obstructive cardiomyopathy
B. Infective endocarditis 
C. Aortic stenosis
D. Aortic regurgitation
E. Mitral stenosis

Answer 25

C. Aortic stenosis

There were no indications of infx, or HOCM. Mitral stenosis tends to develop with Rheumatic heart disease, which the child did not have. Aortic regurgitation is heard louder on the left sternal border.