Murmurs

Question 1

Type
Where heard
Radiation
Symptoms
Association
Causes

Of AORTIC STENOSIS

Answer 1

Type: ejection systolic
Where heard: 2ND ICS LSE
Radiation: Carotids
Symptoms: Dyspnoea, LVHF symptoms, AF, Slow rising pulse
Association: Heaving apex beat, slow rising JVP w/ plateau
Causes: rheumatic fever, congenital, calcification

Question 2

Type
Where heard
Radiation
Symptoms
Association
Causes

Of MITRAL REGURGITATION

Answer 2

Type: pan systolic
Where heard: 5th ICS MAL (Apex)
Radiation: Axilla. Easier to hear if pt rolls onto side
Symptoms: LV Hypertrophy, displaces apex beat, AF
Association: AF
Causes: rheumatic heart disease, AF, IHD

Question 3

Type
Where heard
Radiation
Symptoms
Association
Causes

Of MITRAL PROLAPSE

Answer 3

Type: Late systolic
Where heard: Apex
Radiation: Axilla
Symptoms: SOB, Cough, Palps
Association: Heard halfway through S1
Causes: Hypertrophic cardiomyopathy

Question 4

Type
Where heard
Radiation
Symptoms
Association
Causes

Of AORTIC REGURGITATION

Answer 4

Type: early diastolic
Where heard: 5th ICS LSE
Radiation: Down to tricuspid area. Ask pt to lean forward, exhale and hold
Symptoms: water hammer pulse, corrigans sign (BP higher in legs than arms + prominent carotid pulse)
Association
Causes: rheumatic heart disease, congenital, hypertension

Question 5

Type
Where heard
Radiation
Symptoms
Association
Causes

Of MITRAL STENOSIS

Answer 5

Type: late diastolic
Where heard: mitral area. Ask pt to turn onto left side
Radiation: Rare to hear anywhere other than mitral area
Symptoms: SOB, fatigue
Association: AF
Causes: rheumatic heart disease, congenital

Question 6

When are left and right sided heart murmurs best heard?

Answer 6

lEft on Expiration

rIght on Inspiration

Question 7

What causes a slow rising pulse

Answer 7

Aortic stenosis

Question 8

What causes pulses paradoxus

Answer 8

A paradoxical pulse or pulsus paradoxus occurs in cardiac tamponade and sometimes constrictive pericarditis.

Question 9

Cause of pulses alternates

Answer 9

Alternating pulse occurs in severe left heart failure

Question 10

A biphasic pulse is present when

Answer 10

mixed aortic valve disease and hypertrophic obstructive cardiomyopathy.