Murmurs

Question 1

Aortic stenosis

Answer 1

Ejection systolic, left second IC space, radiating to carotids
Slow rising pulse

Critical AS in newborn - cyanosis, cold peripheries, +/- gallop rhythm on auscultation (often no murmur)

Question 2

Aortic regurgitation

Answer 2

Decrescendo diastolic murmur, left sternal edge 4th IC space
Wide pulse pressure, collapsing pulse

Question 3

Mitral regurgitation

Answer 3

Pansystolic, left 5th IC space midclavicular, radiating to axilla
If acute onset - think IE, rheumatic fever, or post MI LV dilatation

Question 4

Mitral stenosis

Answer 4

Mid diastolic rumbling with opening snap, loudest at axilla when rolled to left

Question 5

VSD

Answer 5

Pansystolic murmur, lower left sternal edge

Question 6

Coarctation of the aorta

Answer 6

Assoc with Turner’s XO
Ejection systolic, left sternal border and back
HTN at young age, often with different BP between arms and legs
Diminished lower extremity pulses

Question 7

Transposition of the great arteries

Answer 7

Most common cyanotic heart disease in first few days of life
NO murmur
Needs urgent surgery