Murmurs

Question 1

mid-diastolic murmur at apex

Answer 1

mitral stenosis

Question 2

pansystolic murmur at apex

Answer 2

mitral regurgitation

Question 3

mitral regurgitation

Answer 3

pansystolic murmur

Question 4

mitral stenosis

Answer 4

mid-diastolic murmur

Question 5

ejection systolic in aortic region

Answer 5

aortic stenosis

Question 6

aortic stenosis

Answer 6

ejection systolic over aortic region

Question 7

aortic regurgitation

Answer 7

early diastolic in left sternal edge

Question 8

early diastolic in left sternal edge

Answer 8

aortic regurgitation

Question 9

mitral valve prolapse

Answer 9

mid systolic click followed by mid or late systolic murmur
at apex

Question 10

tricuspid regurgitation

Answer 10

pansystolic murmur at tricuspid region

Question 11

pulmonary stenosis

Answer 11

ejection systolic murmur over pulmonary area
louder on inspiration
radiates to L shoulder or infraclavicular region

Question 12

tricuspid stenosis

Answer 12

soft diastolic murmur over 3rd-4th intercostal space at left sternal edge
- rarely audible

Question 13

mitral regurgitation features

Answer 13

• Most common
• Displaced apex
• Apical thrill
• S1 quiet
• Pansystolic murmur radiating to the axilla
• S3 present (rapid ventricular filling) Look for valvotomy scar (under the breast)

Question 14

mitral stenosis features

Answer 14

• Malar flush
• Middle aged female
• Atrial fibrillation
• Tapping apex heart (palpable and very low S1, because mitral valve is narrow, atrium has to ↑ contractive force prior to systolic starting)
• Non displaced apex
• RV heave
• Blowing mid diastolic murmur with presystolic accentuation (not AF)

Question 15

aortic regurgitation features

Answer 15

• Collapsing pulse pressure
• Corrigan’s sign (visible neck pulse)
• De Musset’s sign (head nodding with heartbeat)
• Quincke’s sign (capillary pulsation in nail bed)
• Dynamic apex
• Early diastolic murmur at left sternal edge
• Systolic flow murmur
• Luetic, marfans, ankylosing spondylitis, Reiter’s, endocarditis, old rheumatic fever

Question 16

aortic stenosis features

Answer 16

• Slow rising pulse
• Carotid bruit
• Ejection systolic murmur
• 4th heart sound
• Heaving apex
• Ejection click
• Quiet second heart sound

Question 17

differentials for low pitched mid-diastolic murmur heard at apex

Answer 17

• mitral stenosis
• Austin Flint murmur (2^o to AR)
• Carey Coombs murmur (rheumatic fever, mitral valvulitis, disappears when vasculitis improves)
• Tricuspid stenosis (usually rheumatic)

Question 18

differentials for blowing pansystolic murmur at apex

Answer 18

• mitral regurgitation
• VSD (important post MI)
• Tricuspid regurgitation (giant V waves JVP, pulsatile hepatomegaly)
• AS

Question 19

differentials for crescendo-decrescendo ejection systolic murmur over aortic region

Answer 19

• aortic stenosis
• Aortic sclerosis
• HOCM
• Pulmonary stenosis (usually congenital)
• Mitral regurgitation

Question 20

differentials for early diastolic murmur heard when sitting up in expiration at LLSE

Answer 20

• aortic regurgitation
• Pulmonary regurgitation
• Graham Steele murmur (PR secondary to pulmonary HTN)

Question 21

what signs aortic stenosis associated with?

Answer 21

S4, heaving apex, slow-rising, narrow pulse pressure, ejection click, quiet S2 (severe)

Question 22

what signs is AR associated with?

Answer 22

S3, thrusting/displaced apex, collapsing pulse, wide pulse pressure, eponymous signs, Austin flint murmur (mid-diastolic)

Question 23

what signs is MR associated with?

Answer 23

S3, thrusting/displaced apex, quiet S1, obliterated S2, AF

Audible click → valve prolapse

Question 24

what signs is MS associated with

Answer 24

AF, opening snap, tapping apex, loud S1, mitral facies (malar flush), RHF signs