Characterisation of murmurs

Question 1

Murmurs can be ……. or ……..

Answer 1

Physiological or pathological

Question 2

Physiological murmurs include

Answer 2

Ejection murmurs (blood accelerating out of the great vessels),

Filling murmurs (Ventricular filling)

Question 3

Pathological murmurs are diastolic or systolic, these include..

Answer 3

Systolic = mitral regurgitation, tricuspid regurgitation,

Diastolic = Aortic regurgitation

Question 4

Murmurs can be described based on

Answer 4

Timing
Grade
Point of maximal intensity
Radiation
Character and shape

Question 5

Systole describes

Answer 5

between S1 and S2

Question 6

Diastole describe

Answer 6

between S2 and S1

Question 7

What does holo mean when describing a murmur?

Answer 7

Between heart sounds
can still hear the S1 and S2

Question 8

What does pan mean when describing a murmur?

Answer 8

Across heart sounds
Don’t hear S1 and S2

Question 9

What is longer in horses, systole or diastole?

Answer 9

Diastole

Question 10

How many grades of murmurs are there is horses

Answer 10

6

Question 11

Describe a Grade 1 heart murmur

Answer 11

very quiet
localised

Question 12

Describe a grade 2 heart murmur

Answer 12

quieter than S1/S2

Question 13

describe a grade 3 murmur

Answer 13

similar volume to S1/S2

Question 14

Describe a grade 4 murmur

Answer 14

louder than S1/S2

Question 15

Describe a grade 5 murmur

Answer 15

palpable thrill on chest wall

Question 16

Describe a grade 6 murmur

Answer 16

audible with stethoscope off the chest wall

Question 17

How can murmur radiation be charcterised

Answer 17

Cranially
Caudally
Dorsally
Ventrally
Laterally to either side of chest

Question 18

List the 5 ways you and describe the shape of a murmur

Answer 18

Band/plateau
crescendo
decrescendo
crescendo-decrescendo
decrescendo-crescendo

Question 19

Describe a band murmur

Answer 19

the sound is a constant shape- does not change in intensity

Question 20

Describe a Crescendo murmur

Answer 20

murmur has increasing intensity

Question 21

describe a Decrescendo murmur

Answer 21

murmur decreases in intensity as you hear it

Question 22

Describe a Crescendo-Decrescendo mumur

Answer 22

increasing to decreasing intensity of murmur

Question 23

Describe a Decrescendo-crescendo murmur

Answer 23

high intensity to low then back to high intensity

Question 24

List the ways in which we can characterise a murmur

Answer 24

soft harsh
musical
buzzing

blowing
squeak

Question 25

Describe the signalment of mitral regurgitation in horses

Answer 25

all age groups

Question 26

Describe an ejection murmur

Answer 26

blood accelerating out of great vessels (aortic and pulmonic)

Question 27

Describe the clinical signs of mitral regurgitation in horse

Answer 27

Ranges for being incidental to causing collapse and sudden death

Question 28

describe the Timing of mitral regurgitation

Answer 28

Holosystolic Pan systolic Mid to late systolic

Question 29

PMI for a murmur caused by mitral regurgitation

Answer 29

Left side, over the mitral valve

Question 30

Describe the shape of mitral regurgitation murmur

Answer 30

band/plateau crescendo

Question 31

Describe the Signalment for tricupsid regurgitation

Answer 31

All age groups,. racing TB and SB

Question 32

Describe the clinical signs of tricupsid regurgitation

Answer 32

Ranges for being incidental to causing collapse and sudden death

Question 33

Describe the timing of tricuspid regurgitation

Answer 33

Holosystolic Pansystolic

Question 34

Describe the PMI of a murmur caused by tricuspid regurgitation

Answer 34

Right Tricuspid valve

Question 35

Describe the radiation of a tricuspid murmur

Answer 35

cranio-dorsally

Question 36

Radiation of Mitral Regurgitation murmur

Answer 36

Caudo-dorsally

Question 37

Aortic regurgitation is seen in...

Answer 37

Middle aged to older horses

Question 38

Clinical signs of aortic regurgitation

Answer 38

Commonly incidental, progressive, clinical signs as the animal gets older

Question 39

Describe the timing of an aortic regurgitation murmur

Answer 39

Holodiastolic Pandiastolic

Question 40

Describe the PMI of aoritc regurgitation murmur

Answer 40

Left Aortic valve

Question 41

Describe the radiation of aortic regurgitation

Answer 41

caudoventrally, often to right side as well

Question 42

Describe pulmonic insufficency in horses

Answer 42

Uncommon in horses common to see on doppler echocardiography but rarely affects performance

Question 43

List the Well tolerated murmurs in the horse

Answer 43

Physiological murmurs Tricuspid and mitral regurgitation ○ Without structural valvular lesions Slowly progressive Aortic regurgitation in middle-aged horses

Question 44

List poorly tolerated murmurs in the horse

Answer 44

Acute onset murmurs (Ruptured chordae tendinae, Bacterial endocarditis, Valvular disease associated with myocardial disease) Murmur + Concurrent arrhythmias Progressive lesions

Question 45

Describe the Plan for a horse with a murmur

Answer 45

Cardiovascular assessment Characterise the murmur Further investigation?- ECG, echocardiography