Heart Murmurs

Question 1

most common heart murmur

Answer 1

aortic stenosis

Question 2

triad of symptoms in aortic stenosis

Answer 2

syncope, angina, dyspnoea on exertion

Question 3

what type of murmur is aortic stenosis

Answer 3

ejection systolic murmur

Question 4

where is aortic stenosis best heard? where does it radiate to?

Answer 4

aortic area, radiates to carotids

Question 5

what causes aortic stenosis in the elderly?

Answer 5

degenerative calcification

Question 6

what causes aortic stenosis in younger patients? <65 years

Answer 6

congenital bicuspid valve

Question 7

slow rising pulse + narrow pulse pressure is seen with which heart murmur

Answer 7

aortic stenosis

Question 8

what might happen to the heart sounds in aortic stenosis

Answer 8

quiet S2

may have 4th heart sound

Question 9

what investigation is definitive for valvular disease

Answer 9

echo- transthoracic or trans oesophageal

Question 10

management of aortic stenosis if asymptomatic

Answer 10

observe + modify cardiac risk factors

6 monthly echo

Question 11

management of aortic stenosis if severe + symptomatic and fit for surgery

Answer 11

surgical aortic valve replacement (SAVR)

• mechanical valve: last longer but require anti-coagulation
• bioprosthesis: fail sooner but only require 3 months aspirin

Question 12

management of aortic stenosis if severe + symptomatic but not fit for surgery

Answer 12

TAVI (transcatheter aortic valve implantation)

Balloon valvuloplasty - temporary relief (6-12 months), used as bridge to TAVI in unstable patients