Cardiology - murmurs

Question 1

S1 heart sound

Answer 1

Mitral and tricuspid valve closure

Lub

Question 2

S2 heart sound

Answer 2

Aortic and pulmonary valve closure
End of ventricular systole
Dub

Question 3

Split-S1

Answer 3

S1 is heard as two adjacent sounds

Mitral and tricuspid valve closure offset

Question 4

Split-S2

Answer 4

S2 is heard as two adjacent sounds

Closure of aortic and pulmonic valves offset

Question 5

S3

Answer 5

Additional heart sound.
S3 produced during passive left ventricular filling when blood strikes a compliant left ventricle.
Kentucky

Question 6

S4

Answer 6

This is an additional sound – occurs before S1
Results from a forceful atrial contraction during presystole that ejects blood into a hypertrophied ventricle which cannot expand further
Tennessee

Question 7

Which of the following does not cause a systolic murmur?

Atrial septal defect
Ventricular septal defect
Hypertrophic obstructive cardiomyopathy (HOCM)
Aortic regurgitation
None of the above

Answer 7

Aortic regurgitation

Early-diastolic

Question 8

Pan-systolic murmurs?

Answer 8

Regurgitation murmurs:
Tricuspid regurgitation
Mitral regurgitation
Ventricular Septal Defect (VSD)

Question 9

Mid-systolic murmur?

Answer 9

Stenosis:

AS

Question 10

Late-systolic murmur?

Answer 10

Valve prolapse

Question 11

Early-diastolic murmurs?

Answer 11

Regurg:
AR
Pulmonary regurg

Question 12

Mid-diastolic murmurs?

Answer 12

Stenosis:
MS
TS

Question 13

You perform a cardiovascular examination on an elderly gentleman who reports episodes of collapsing and often wakes up short of breath at night. Upon auscultation you discover an ejection systolic murmur, which radiates to the carotids.

Aortic stenosis
Aortic regurgitation
Mitral regurgitation
Tricuspid regurgitation 
Mitral stenosis

Answer 13

Aortic stenosis

Question 14

AS symptoms and signs?

Answer 14

Symptoms:
Collapse
Worsening SOB(OE)
Paroxysmal nocturnal dyspnoea
Leg swelling

Signs:
Crescendo decrescendo systolic murmur
ESM
Heaving apex beat
Narrowed pulse pressure (eg.110/94)
ECG - LVH evidence

Question 15

A 53-year-old woman with Atrial Fibrillation is reviewed by her cardiologists. On inspection the patients cheeks appear quite flushed. Auscultation reveals a very loud S1 and a mid diastolic murmur.

Mitral stenosis
Graham Steell
Mitral regurgitation
Aortic regurgitation
Austin Flint

Answer 15

Mitral stenosis

Question 16

Graham Steell?

Answer 16

Associated with pulmonary regurgitation
High-pitched early diastolic murmur
Best heard at the left sternal edge at full inspiration

Question 17

Austin Flint?

Answer 17

Aortic Incompetence - caused by aortic regurg.
Due to noise of turbulent blood flow hitting the anterior leaflets of mitral valve
Mid-diastolic
Heart best at apex beat

Question 18

Mitral stenosis?

Answer 18

Mid-diastolic murmur
Opening snap!
Often associated with AF and rheumatic fever
Accentuated by patient lie on left
Red cheeks

Question 19

49-year-old women presents with 3 month history of increasing SOB on exertion. She has no chest pain, cough or ankle swelling. On examination: BP 158/61 and there are crackles at the bases of both lungs. On Auscultation you hear a diastolic decrescendo murmur loudest at the left sternal edge.

Aortic regurgitation
Aortic stenosis
Mitral regurgitation
Mitral stenosis
Tricuspid regurgitation

Answer 19

Aortic regurgitation

Question 20

Aortic regurgitation?

Answer 20

Similar symptoms to HF: SOB, paroxysmal nocturnal dyspnoea, collapse
Wide pulse pressure
Watson’s water hammer pulse (aka Corrigan’s pulse/ collapsing pulse)
Quincke’s sign
De Musset’s sign
Becker’s sign

Question 21

Causes of Mobitz Type I HB?

Answer 21

AV nodal disease usually due to drugs (beta-blockers) but can be due to inferior MI

Question 22

Causes of Mobitz Type II HB?

Answer 22

His-Purkinje system disease usually due to tissue damage (infarction)

Question 23

What does 3rd degree HB cause?

Answer 23

Leads to severe bradycardia, hypotension and haemodynamic instability