Murmurs

Question 1

which murmur has a slow rising and slow falling pulse?

Answer 1

aortic stenosis

Question 2

aortic stenosis classically prevents with which triad?

Answer 2

angina
dyspnoea
syncope

Question 3

which kind of murmur is aortic stenosis?

Answer 3

ejection systolic

Question 4

aortic stenosis in </> 60 is generally due to what?

Answer 4

<60 yo’s is due to calcification of congenital bicuspid valve

> 60 yo’s is due to degenerative calcification of valve due to age

Question 5

which murmur is described as decrescendo diastolic character?

Answer 5

pulmonary regurgitation

Question 6

what are the signs of aortic regurgitation?

Answer 6

wide pulse pressure
collapsing pulse
apex displaced laterally, downwards
high pitched early diastolic murmur heard at left sternal edge

Question 7

which murmur has a tapping apex?

Answer 7

mitral stenosis

Question 8

much sided murmurs are louder with inspiration?

Answer 8

right side

Question 9

which drugs are used for acute aortic regurgitation?

Answer 9

vasodilators and inotropes

Question 10

individuals with chronic severe aortic regurgitation and heart failure can be given which drugs?

Answer 10

ACEi

Question 11

which drugs may slow aortic dilation in Marfan’s patients?

Answer 11

Beta blockers

Question 12

which murmur is indicated for surgery when there is LV deterioration and symptoms?

Answer 12

aortic regurgitation

Question 13

what does aortic dissection show on CXR?

Answer 13

cardiomegaly

Question 14

what are characteristics of aortic stenosis murmur?

Answer 14

radiates to carotids
slow rising pules
forceful displaced apex
ejection systolic murmur

Question 15

which kind of murmur is aortic stenosis?

Answer 15

ejection systolic

Question 16

which murmur has a slow rising pulse?

Answer 16

aortic stenosis

Question 17

which murmur can progress to LBBB?

Answer 17

aortic stenosis

Question 18

what is the management for aortic stenosis?

Answer 18

• Conventional valve replacement (preferred, if symptomatic)
• Patients who would not tolerate an operation under anaesthesia - TAVI (trans catheter aortic valve replacement)
• BAV (balloon aortic valvotomy) break calcifications, it is a stent, used if above 2 cannot be

Question 19

which drug do prosthetic heart valve patients need to be followed up on?

Answer 19

warfarin

Question 20

which murmur can commonly cause AF?

Answer 20

mitral regurgitation/ stenosis

due to increased left atrial pressure

Question 21

which murmur is pansystolic?

Answer 21

mitral regurgitation

Question 22

chordal rupture is a cause of which murmur?

Answer 22

mitral regurgitation

Question 23

peripheral oedema is a symptom of which murmur?

Answer 23

mitral regurgitation

Question 24

which drugs are used in mitral regurgitation?

Answer 24

diuretics
ACEi if heart failure develops

Question 25

when are valves repaired/ replaced in mitral regurgitation?

Answer 25

repair if prolapsed replace if degenerative

Question 26

rheumatic fever is the most common cause of which murmur?

Answer 26

mitral stenosis

Question 27

malar flush is a sign of which murmur?

Answer 27

mitral stenosis

Question 28

a thrill may be present in which murmur?

Answer 28

mitral stensosis

Question 29

which murmur is mid diastolic?

Answer 29

mitral stenosis

Question 30

what are symptoms of mitral stenosis?

Answer 30

dyspnoea fatigue palpitations (AF)

Question 31

what are the medical and surgical therapies for mitral stenosis?

Answer 31

diuretics treat AF valve replacement balloon valvuloplasty (if cannot tolerate valve replacement)

Question 32

which murmur shows straight left heart border on CXR?

Answer 32

mitral stenosis

Question 33

what are innocent murmurs due to?

Answer 33

increased blood flow common in children/ young adults

Question 34

are innocent murmurs systolic or diastolic?

Answer 34

early systolic