Murmurs

Question 1

How does valvular heart disease affect its preceding chamber?

Answer 1

A stenosed valve may cause its preceding chamber to experience pressure overload, which at lead to chamber hypertrophy.

Regurgitation tends towards volume overload, which may lead to chamber dilation and failure.

Question 2

What is a murmur?

Answer 2

A murmur is defined as a pathological heart sound, produced over a region of turbulent blood flow.

Question 3

How can murmurs be graded?

Answer 3

Using the Levine scale:

Grade I - very faint, almost inaudible

Grade II - quiet, audible

Grade III - clearly audible

Grade IV - loud with associated thrill

Grade V - very loud, with thrill, audible with rim of stethoscope

Grade VI - audible without stethoscope placed on chest

Question 4

Mitral stenosis murmur character

Best heard and radiation

Answer 4

Low pitched, rumbling, mid-diastolic murmur

Apex in left lateral position, loudest on expiration using bell of stethescope

Question 5

Causes of mitral stenosis

Answer 5

Rheumatic heart disease is the main cause

Question 6

Symptoms of mitral stenosis

Answer 6

• Dyspnoea
• Fatigue
• Haemoptysis
• Chest pain

Question 7

Signs of mitral stenosis

Answer 7

• Malar flush (due to low cardiac output)
• AF
• Tapping apex (palpable S1)
• Loud S1
• Signs of pulmonary hypertension (RV heave, loud P2)

Question 8

Mitral regurgitation murmur character

Best heard/radiation

Answer 8

Pansystolic

Heard best at the apex, radiates to the axilla

Question 9

Causes of mitral regurgitation

Answer 9

• Papillary muscle dysfunction (post-MI)
• Rheumatic heart disease
• Infective endocarditis
• Connective tissue disorders

Question 10

Symptoms of mitral regurgitation

Answer 10

• Dyspnoea
• Orthopnoea
• Paroxysmal nocturnal dyspnoea
• Fatigue
• Palpitations

Question 11

Signs of mitral regurgitation

Answer 11

• AF
• Displaced thrusting apex (volume loaded)
• Signs of pulmonary hypertension (RV heave, loud P2)
• May be signs of LVF (S3, pulmonary oedema)

Question 12

Aortic stenosis murmur character

Best heard/radiation

Answer 12

Ejection systolic

Aortic region, radiates to carotids and axilla

Question 13

Aortic stenosis causes

Answer 13

• Idiopathic age related calcification
• Rheumatic heart disease
• Bicuspid aortic valve eg Turner’s syndrome

Question 14

Symptoms of aortic stenosis

Answer 14

• Exertional dyspnoea
• Syncope
• Angina

Question 15

Signs of aortic stenosis

Answer 15

• Slow rising pulse
• Narrow pulse pressure
• Heaving apex beat
• May be signs of LVF (S3, pulmonary oedema)

Question 16

Aortic regurgitation murmur characteristic

Best heard/radiation

Answer 16

Early diastolic, soft murmur

Upper right sternal edge or left lower sternal edge in expiration

Question 17

Causes of aortic regurgitation

Answer 17

• Acute
  
  • Infective endocarditis
  • Aortic dissection
• Chronic
  
  • Connective tissue disorders
  • Rheumatic heart disease

Question 18

Symptoms of aortic regurgitation

Answer 18

• Fatigue
• SOB
• Palpitations

Question 19

Signs of aortic regurgitation

Answer 19

• Collapsing pulse
• Wide pulse pressure
• Displaced thrusting apex beat (volume loaded)