Features of heart murmurs

Question 1

Patent Ductus Arteriosus

Answer 1

left subclavicular thrill
continuous 'machinery' murmur
large volume, bounding, collapsing pulse
wide pulse pressure
heaving apex beat

Question 2

Fourth heart sound (S4)

Answer 2

Systemic Hypertension
Aortic Stenosis
HOCM

Question 3

Loud S1

Answer 3

Hyperdynamic states

Mitral stenosis

Question 4

Atrial septal defect

Answer 4

fixed split S2

Question 5

RBBB

Answer 5

Widely split S2

Question 6

Ejection Systolic Murmur

Answer 6

aortic stenosis
Pulmonary stenosis,
HOCM
Atrial septal defect

Question 7

Holosystolic (pansystolic) murmurs

Answer 7

mitral/tricuspid regurgitation (high-pitched and ‘blowing’ in character)
VSD (‘harsh’ in character)

Question 8

Late systolic murmurs

Answer 8

mitral valve prolapse

coarctation of aorta

Question 9

Early diastolic murmurs

Answer 9

Aortic regurgitation
Pulmonary regurgitation

Both are - high-pitched and ‘blowing’ in character

Question 10

Mid-late diastolic murmurs

Answer 10

mitral stenosis ('rumbling' in character)
Aortic regurgitation ('rumbling' in character)

Question 11

Continuous machine-like mumur

Answer 11

patent ductus arteriosus

Question 12

Soft S1

Answer 12

Mitral regurgitation

Question 13

Soft S2

Answer 13

Aortic stenosis

Question 14

Third heart sounds (S3)

Answer 14

Mitral regurgitation

Question 15

Loud S2

Answer 15

Pulmonary and systemic hypertension

Question 16

Reversed split S2

Answer 16

Aortic stenosis

Question 17

Widely split S2

Answer 17

Mitral regurgitation
Pulmonary stenosis
RBBB

Question 18

Slow rising pulse

Answer 18

aortic stenosis

Question 19

Collapsing pulse

Answer 19

Aortic regurgitation

Patent ductus arteriosus

Question 20

MITRAL STENOSIS

Answer 20

MID-LATE DIASTOLIC MURMUR (best heard in expiration)
RUMBLING
loud S1 - opening snap
low volume pulse
malar flush
atrial fibrillation

Question 21

MITRAL REGURGITATION

Answer 21

PAN-SYSTOLIC MURMUR
Can radiate to the axilla
soft S1
split S2

Question 22

AORTIC REGURGITATION

Answer 22

EARLY DIASTOLIC MURMUR
heard at the left sternal edge
decrescendo 
collapsing pulse
wide pulse pressure

Question 23

AORTIC STENOSIS

Answer 23

SYSTOLIC EJECTION MURMUR 
Can radiate to the neck 
Crescendo- Decrescendo 
Presence of S4
Soft S2

Question 24

What sound can hyper dynamic states cause?

Answer 24

A loud S1

Question 25

What can an atrial septal defect cause?

Answer 25

A fixed split S2

Question 26

Why can mitral stenosis cause a cough productive of frothy sputum?

Answer 26

Mitral stenosis affects the left side of the heart and thus can cause pulmonary hypertension and pulmonary oedema - leading to frothy sputum.

Question 27

Explain pulse pressures - what is meant by a wide or a narrow pulse pressure?

Answer 27

Pulse pressure is the difference between diastolic and systolic blood pressure

• A narrow pulse pressure means there is only a small difference between the diastolic and systolic values
• A wide pulse pressure means there is a large difference between diastolic and systolic values.