Heart murmurs

Question 1

features of a normal cardiac cycle

Answer 1

duration ~1 second

consisting of systole and diastole

Question 2

Systole is

Answer 2

Contraction of ventricles
ventricular pressure > atrial pressure, closing valves (mitral and tricuspid)
ventricular pressure > aortic pressure, opening valves

Question 3

the closure of which valves creates S1

Answer 3

Mitral and tricuspid

Question 4

Diastole is

Answer 4

relaxation of ventricles
Ventricular pressure < aortic pressure (aortic and pulmonary valves close)
Ventricular pressure < atrial pressure, opening M+T valves
passive filling begins
Atria contract to complete filling

Question 5

the closure of which valves generates S2

Answer 5

Aortic and pulmonary

Question 6

S3 occurs when?

Answer 6

in early diastole, caused by blood oscillating in the ventricle due to rapid filling

Question 7

S4 occurs when?

Answer 7

before S1 in late diastole, due to blood being forced into a stiff ventricle by atrial contraction

Question 8

Murmurs on which side will increase on inspiration?

Answer 8

Right side. increased venous return to the right atria during inspiration, which leads to an increase in stroke volume of the right ventricle during systole

Question 9

List the systolic murmurs

Answer 9

Ejection systolic
Pansystolic
Late systolic
(during the carotid pulse, after S1)

Question 10

List diastolic murmurs

Answer 10

Early diastolic
Mid diastolic
(after S2, not during pulse)

Question 11

Ejection murmurs

Answer 11

S1 I<>I S2

I<>I I<>I

Question 12

Early diastolic murmur

Answer 12

S1 S2 S1 S2

I I> I I>

Question 13

Continuous murmur

Answer 13

S1 S2 S1 S2

Question 14

Grading of murmurs

Answer 14

I. barely audible
II. soft, easily audible
III. moderately loud, no thrill (roughly as loud as S1/S2)
IV. loud with a thrill
V. audible with stethoscope barely on chest
VI. audible with stethoscope off

Question 15

site of aortic murmurs

Answer 15

Aortic systolic: upper right sternal edge

Aortic diastolic: Lower left sternal edge

Question 16

Ejection systolic murmurs

Answer 16

Harsh crescendo/decrescendo
narrowing/stenosis
loudest over aortic (usually) or pulmonary area
radiates to neck

Question 17

Pan systolic murmur

Answer 17

Continuous blowing murmur
regurgitant valve
loudest at apex/lower left sternal edge
radiates to axilla (mitral regurg)

Question 18

Late systolic murmur

Answer 18

(rare)
prolapse of mitral valve
opening click followed by late systolic blowing over apex

Question 19

early diastolic murmur

Answer 19

soft, often difficult to hear
high pitched
heard over aortic area
radiates down LLSE

Question 20

Mid diastolic murmur

Answer 20

low pitched rumbling
heard over apex with bell
heard best in lateral decubitus position in held expiration
often have a loud S1, often in AF

Question 21

Mid diastolic murmur

Answer 21

low pitched rumbling
heard over apex with bell
heard best in lateral decubitus position in held expiration
often have a loud S1, often in AF

Question 22

Valvular aortic stenosis causes

Answer 22

Age related calcification (commonest)
Bicuspid aortic valve (young adults)
supravalvular: fibrous tissue in aortic root
subvalvular: fibromuscular ring
radiates to carotids

Question 23

Sx of AS

Answer 23

Angina, exertional dyspnoea, syncope, presyncope
Angina/syncope (mean survival 2 years)
HF (mean survival 1 year)

Question 24

Mitral regurg

Answer 24

Functional MR: dilatation in IHD, LVF
degenerative mitral valve disease, old age
infective endocarditis
connective tissue disorders: SLE, Marfans
Floppy valve

Question 25

Tx of MR

Answer 25

treat HF
diuretics
manage AF
mitral valve surgery of severe/symptomatic MR

Question 26

Aortic regurg

Answer 26

congenital, associated with bicuspid aortic valve
valve disease: infective endoscarditis, rheumatoc, connectove tissue disorders
Aortic root disease: dissection, HTN, marfans, arthrits (e.g ank spond), psoriasis

Question 27

Sx of AR

Answer 27

most asymptomatic as AR well tolerated. Sx of HF once LV is dilated

Question 28

Mitral valve disease

Answer 28

MS: almost always rheumatic
dyspnoea, orthopnea, PND
Fatigue due to low CO
high risk of systemic emboli, most develop AF