Heart Murmurs

Question 1

Questions to ask in a history with a murmur?

Answer 1

Breathlessness
Chest Pain
Effort intolerence / fatigue
Previous Rheumatic Fever
Known Congenital Heart Disease
Previous MI

Question 2

What is Endocarditis?

Answer 2

Inflammation of the inner layer of the heart (the endocardium)

Question 3

What’re the signs of Endocarditis?

Answer 3

Fever
Haematuria
Splinter Haemorrhages (30%)

Question 4

What are intermittent murmurs / sounds caused by?

Answer 4

Benign ‘flow’ murmurs
Floppy mitral valve (mid-systolic click)
Pericardial rubs
Atrial myxoma (very rare - a benign tumor of the heart, commonly found within the left and right atria on the interatrial septum)

Question 5

What’re the features of a benign murmur?

Answer 5

Systolic not diastolic
Normal ECG, CXR
No cardiac symptoms or signs

Question 6

What’re the Benign Flow murmurs caused by?

Answer 6

1. Increased Cardiac Output - Fever, Anaemia, Pregnancy, Thyrotoxicosis
2. Small Size - Women, Children

Question 7

As a Rule Narrow AV valves cause (diastolic / systolic) murmurs

Answer 7

As a Rule Narrow AV cause diastolic murmurs

Question 8

As a Rule Leaking AV valves caused (diastolic / systolic) murmurs

Answer 8

As a Rule Leaking AV valves caused systolic murmurs

Question 9

What causes stenosis of a valve?

Answer 9

Chronic scarring and calcification - causes pressure overload on the cardiac camber pumping blood through the valve

Question 10

What causes valve incompetency (regurgitation)?

Answer 10

A destructive process e.g endocarditis or vasculitis - results in volume overload