Murmurs

Question 1

What are murmurs?

Answer 1

Heart sounds caused by turbulent blood flow

Question 2

Which 2 murmurs can you extenuate using dynamic manoeuvres?

Answer 2

1. Aortic regurgitation

2. Mitral Stenosis

Question 3

How can you emphasise a mitral stenosis murmur?

Answer 3

Lie the patient on their left, listen to the apex/mitral area with the BELL whilst they hold their breath on deep expiration.

Question 4

How can you emphasise an aortic regurgitation murmur?

Answer 4

Sit the patient forward and listen to the lower LSB (tricuspid area) with the DIAPHRAGM whilst they hold their breath on deep expiration.

Question 5

Murmur that causes collapsing pulse?

Answer 5

Aortic Regurgitation

Question 6

Murmur that causes pulsating nail beds (Quincke’s sign)

Answer 6

Aortic Regurgitation

Question 7

Murmur that causes a visibly pulsating carotid? (Corrigan’s sign)

Answer 7

Aortic Regurgitation

Question 8

Murmur that causes a head bopping pulse (De Musset’s sign)?

Answer 8

Aortic Regurgitation

Question 9

Murmurs that can cause a displaced apex beat?

Answer 9

Aortic and Mitral Regurgitation

Question 10

Murmur that causes a wide pulse pressure?

Answer 10

Aortic Regurgitation

Question 11

What are narrow and wide pulse pressures? Which murmurs cause them?

Answer 11

The difference between diastolic and systolic are wide or narrow.

1. narrow = aortic stenosis
2. wide = aortic regurgitation

Question 12

Murmur that causes a slow rising pulse?

Answer 12

Aortic Stenosis

Question 13

Murmur that causes a heaving apex beat?

Answer 13

Aortic Stenosis

Question 14

What are the 3 classical symptoms of Aortic Stenosis?

Answer 14

“SAD”
Syncope (exertional)
Angina pain
Dyspnoea (exertional)

Question 15

Early diastolic murmur

Answer 15

Aortic Regurgitation

Question 16

Ejection systolic murmur (2)

Answer 16

1. Aortic Stenosis

2. Pulmonary Stenosis

Question 17

Pan systolic murmur (2)

Answer 17

1. Mitral Regurgitation

2. Tricuspid Regurgitation

Question 18

Murmur that causes a narrow pulse pressure?

Answer 18

Aortic Stenosis

Question 19

Murmur that causes a parasternal heave?

Answer 19

Tricuspid Regurgitation

Question 20

Commonest cause of Aortic Stenosis?

Answer 20

Age-related calcification

Question 21

Mid-diastolic murmur

Answer 21

Mitral Stenosis

Question 22

Murmur that causes Malar flush?

Answer 22

Mitral StenoSiS

Question 23

The 2 murmurs that can present with AF?

Answer 23

1. Mitral Regurgitation

2. Mitral Stenosis

Question 24

Murmur that causes a tapping apex beat

Answer 24

Mitral Stenosis

Question 25

Murmur that can present with signs of hepatic pain, oedema, ascites?

Answer 25

Tricuspid Regurgitation

Question 26

Murmur that can present with signs of LVHF (S3 gallop, pulmonary oedema)

Answer 26

Mitral Regurgitation

Question 27

Murmur that can radiate to the carotids

Answer 27

Aortic Stenosis

Question 28

Murmur that can radiate to the axilla?

Answer 28

Mitral Regurgitation

Question 29

Condition that produces a continuous machinery murmur

Answer 29

Patent Ductus Arteriosus

Question 30

Murmur that radiates to the back?

Answer 30

Pulmonary Stenosis

Question 31

Name of the tool used to grade the intensity of a murmur?

Answer 31

Levine

Question 32

Patients with murmurs will classically present with what type of symptoms? (3)

Answer 32

Dyspnoea, fatigue, palpitation