CVS

Question 1

AS murmur

Answer 1

ESM, Loudest on Expiration
Radiate to Carotid

Question 2

AS Clinical signs

Answer 2

slow rising pulse
narrow pulse pressure <25mmHg
HP: Heaving pressure
Thrill in aortic are

Question 3

AS Causes

Answer 3

Congenital: Bicuspid
Acquired: Age- senile, streptococcal (Rheumatic)

Ddx : HOCM, VSD, Aortic sclerosis, Aortic flow (high output- pregnancy, anemia)

Question 4

AS Associations

Answer 4

• Coarctation & Bicuspid aortic valve
• Angiodysplasia - Heyde syndrome

Question 5

AR murmur

Answer 5

• EDM, Loudest Left sternal edge with patient sat forward in Expiration
• Presence of aortic flow and mid diastolic murmur “Austin flint”

Question 6

Severe AR murmur

Answer 6

“free flow” regurgitation and EDM may be silent

Question 7

AR Clinical signs

Answer 7

• Collapsing pulse (wide PP >60-70)
• Apex beat- displaced, hyperkinetic
• Thrill in aortic

Question 8

AR signs of severity

Answer 8

• Collapsing pulse
• S3
• Pulmonary oedema

Question 9

AR- Eponymous signs

Answer 9

• Corrigan
• Quincke
• De Musset
• Duroziez
• Traube

Question 10

MS murmur

Answer 10

Opening snap followed by mid diastolic murmur
- Best at Apex, left lateral position in Expiration with Bell

Question 11

Severe MS

Answer 11

OS nearer AR and MDM longer

Question 12

MS Clinical signs

Answer 12

malar flush
irregular pulse if AF present
Tapping apex (palpable S1)
Left parasternal heave if pulmonary HTN present or enlarge left atrium

Question 13

MS Cause

Answer 13

commonest- Rheumatic
senile degeneration
large mitral leaflet vegetation from endocarditis

Ddx
Left atrial myxoma
Austin flint murmur - mid to late diastolic rumbling murmur (severe AR)

Question 14

MR murmur

Answer 14

PSM -loudest at apex and expiration, radiate to axilla
Wide split A2P2(due to earlier closure of A2 because LV emptying sooner)
S3