Murmurs

Question 1

Which of the following is a clinical marker of severe aortic stenosis (AS)?

Answer 1

1- ejection systolic murmur, loudest over the aortic area

2- soft second heart sound (s2)

Question 2

Wide pulse pressure is a sign of

Answer 2

aortic regurgitation (AR).

Question 3

What are the clinical presentations of aortic stenosis?

Answer 3

Syncope, Shortness of Breath and Angina

Question 4

What type of murmur and where will aortic stenosis be heard?

Answer 4

Ejection Systolic Murmur, heard best over right Upper Right Sternal Edge

Question 5

What type of murmur and where will mitral regurgitation be heard?

Answer 5

Pansystolic Murmur, best heard over the Apex

Question 6

HARD ASS MRS MSD
Abbreviate meaning-

Answer 6

Aortic Regurgitation- Diastolic
Aortic Stenosis- Systolic
Mitral Regurgitation- Systolic
Mitral Stenosis- Diastolic

Question 7

What does the open snap indicate in mitral stenosis?

Answer 7

Indicates the leaflets still have some mobility. (remember it is bicuspid)

Question 8

Features of mitral stenosis

Answer 8

dyspnoea
haemotypsis
mid late diastolic murmur
MALAR FLUSH
loud S1
opening snap

Question 9

armsprts

Answer 9

diastolic

Question 10

psasmrtr

Answer 10

systolic

Question 11

early diastolic murmur: intensity of the murmur is increased by the handgrip manoeuvre

collapsing pulse

wide pulse pressure

Quincke’s sign (nailbed pulsation)

De Musset’s sign (head bobbing)

mid-diastolic Austin-Flint murmur in severe ….- due to partial closure of the anterior mitral valve cusps caused by the ……..streams

These features, what do they indicate?

Answer 11

Aortic Regurgitation

Question 12

Which of the following is a clinical marker of aortic regurgitation (AR)?

Answer 12

• Quincke’s sign (nailbed pulsation) is a clinical sign of aortic regurgitation
• Early/ Mid-late diastolic Murmur

Question 13

Suspected AR should be investigated with ……..

Answer 13

echocardiography

Question 14

Management of AR

Answer 14

medical management of any associated heart failure

surgery: aortic valve indications include:

• symptomatic patients with severe AR
• asymptomatic patients with severe AR who have LV systolic
  dysfunction

Question 15

Chronic Presentation of;

rheumatic fever: the most common cause in the developing world

calcific valve disease

connective tissue diseases e.g. rheumatoid arthritis/SLE

bicuspid aortic valve (affects both the valves and the aortic root)

This features what do they indication, what could be a possible cause?

Answer 15

AR, due to valvular disease

Question 16

Acute Presentation of ;

• infective endocarditis

This feature what do they indication, what could be a possible cause?

Answer 16

AR, due to valvular disease

Question 17

Chronic Presentation of;

bicuspid aortic valve (affects both the valves and the aortic root)

spondylarthropathies (e.g. ankylosing spondylitis)

hypertension

syphilis

Marfan’s, Ehler-Danlos syndrome

This features what do they indication, what could be a possible cause?

Answer 17

AR, due to aortic root disease

Question 18

Acute Presentation of ;

• aortic dissection

This feature what do they indication, what could be a possible cause?

Answer 18

AR, due to aortic root disease

Question 19

RheuMATic fever affects: Mitral valve > Aortic valve&raquo_space; Triscuspid valve, in order of frequency (from USMLE FirstAid 2020)

Answer 19

RheuMATic fever affects: Mitral valve > Aortic valve&raquo_space; Triscuspid valve, in order of frequency (from USMLE FirstAid 2020)

Question 20

A late systolic murmur is typically associated with ….

Answer 20

coarctation of the aorta and mitral valve prolapse.

Question 21

A pan-systolic murmur may be present in…..

Answer 21

mitral or tricuspid regurgitation, and ventricular septal defects.

Question 22

A continuous, machine-like murmur is the typical murmur associated with….

Answer 22

patent ductus arteriosus (PDA). This most commonly presents in infancy.

Question 23

An ejection systolic murmur is most commonly associated with

Answer 23

• aortic stenosis (AS) or hypertrophic obstructive cardiomyopathy (HOCM) if louder on expiration
• pulmonary stenosis
• atrial septal defect if louder on inspiration
• It may also be present in tetralogy of Fallot.

Question 24

In mild AR, the murmur is typically ……..diastolic, and in severe AR, the murmur may be ………… diastolic.

Answer 24

In mild AR, the murmur is typically early diastolic, and in severe AR, the murmur may be mid-late diastolic.

Question 25

Narrow Pulse Pressure seen in,

Answer 25

Aortic Stenosis

Question 26

Collapsing Pulse seen in,

Answer 26

Aortic Regurgitation

Question 27

Corrigan’s sign refers to the rapid upstroke and collapse of the carotid artery pulse, also seen in .

Answer 27

aortic regurgitation

Question 28

Differentiate both Tricuspid regurgitation and mitral regurgitation, both have pan systolic murmur.

Answer 28

Tricuspid regurgitation becomes louder during inspiration, unlike mitral regurgitation

Question 29

Mnemonic of RILE, interpret it

Answer 29

RILE
Right-sided murmur → heard best on Inspiration
Left-sided murmur → heard best on Expiration

Question 30

Ejection systolic in loud in inspiration

Answer 30

-louder on inspiration

pulmonary stenosis

atrial septal defect

also: tetralogy of Fallot

Question 31

Late systolic

Answer 31

mitral valve prolapse

coarctation of aorta

Question 32

Early diastolic

Answer 32

aortic regurgitation (high-pitched and ‘blowing’ in character)

Question 33

Mid-late diastolic

Answer 33

mitral stenosis (‘rumbling’ in character)

Question 34

Continuous machine-like murmur

Answer 34

patent ductus arteriosus

Question 35

Holosystolic (pansystolic)

Answer 35

• mitral/tricuspid regurgitation (high-pitched and ‘blowing’ in character)

(tricuspid regurgitation becomes louder during inspiration, unlike mitral reguritation)

• ventricular septal defect (‘harsh’ in character)

Question 36

Ejection systolic in loud in expiration

Answer 36

-louder on expiration

aortic stenosis

hypertrophic obstructive cardiomyopathy

Question 37

chest reveals a systolic murmur heard loudest at the left sternal edge and bilateral femoral pulses are weak.

Answer 37

coarctation of aorta

Question 38

Aortic stenosis - What is the most common cause in
younger patients < 65 years:

Answer 38

bicuspid aortic valve

Question 39

Aortic stenosis - What is the most common cause in
older patients > 65 years:

Answer 39

calcification