Heart murmurs

Question 1

What can be heard over the carotids and what is it an indication of ?

Answer 1

• Carotid bruits is a sign of atherosclerosis.
• Ask the patient to hold breath and there will be radiation of an ESM like in aortic stenosis.

Question 2

What type of murmur is found in aortic stenosis and where is it heard ?

Answer 2

Ejection systolic (whoosh sound)
Over the aortic valve.

Question 3

What type of murmur is heard in aortic regurgitation and where. What can be done to make this louder ?

Answer 3

An early diastolic murmur (second heart sound is accentuated, dum duuuuummmmmm).
Aortic area
Sit the patient forwards and listen on expiration with the diaphragm (big side of the stethoscope)

Question 4

What murmur is found in pulmonary stenosis and where is it found ?

Answer 4

Systolic ejection murmur.
Over the pulmonary area.

Question 5

What murmur is heard in mitral regurgitation and where. What can be done to exacerbate this ?

Answer 5

• Pansystolic murmur (whoos whoos)
• over the mitral valve.
• Roll patient onto left side and listen with the diaphragm (Big side) and listen for radiation

Question 6

What murmur is heard in mitral stenosis and where. What can be done to exacerbate this ?

Answer 6

Mid diastolic murmur (dum dummmm)
Mitral area
Roll patient to the side and listen with the bell (small side)

Question 7

What is a risk factor in tall slender men for aortic regurgitation ?

Answer 7

MARFAN syndrome

Question 8

ECG changes in what leads indicate anterior/septal pathology ?

Answer 8

V1-V4

Question 9

ECG changes in what leads indicate lateral pathology ?

Answer 9

V5/6 and L1 (avl in high lateral)

Question 10

ECG changes in what region indicate inferior pathology ?

Answer 10

L2, L3 and aVF

Question 11

What causes an asymptomatic pansystolic murmur on the left sternal edge ?

Answer 11

Ventricular septal defect

Question 12

Why does rheumatic fever cause mitral regurgitation ( blowing systolic murmur) ?

Answer 12

Due to valvulitis