Murmurs

Question 1

Splitting of S1

Answer 1

Occurs if there is pacing which triggers RV before LV

Or if mitral valve closure is delayed by high left atrial pressure, or an atrial myoxma

Question 2

Splitting of S2

Answer 2

Wide fixed splitting in atrial septal defect

Question 3

Soft heart sounds

Answer 3

Severe mitral regurgitation
Calcification
Severe aortic regurgitation
Left bundle branch block

Question 4

Prosthetic heart sounds

Answer 4

Mitral valve- loud ‘opening snap’ occurs after S2

Aortic valve- loud S2, ejection click after S1, ejection systolic murmur

Question 5

3rd heart sound

Answer 5

Heart failure
Gallop rhythm
Can be innocent under 30

Question 6

4th heart sound

Answer 6

Before the first heart sound
Abnormal opening of mitral and/or tricuspid which open as atria are contracting
Can’t occur in AF
Ventricular hypertrophy, arrhythmias, coronary heart disease, heart block

Question 7

Aortic stenosis

Answer 7

Calcification, congenital, rheumatic 
Chest pain, heart failure, syncope
Angina, dizziness, SoB on exertion 
Loud ejection systolic murmur, ‘crescendo-decrescendo’
Radiates to carotids

Question 8

Aortic regurgitation

Answer 8

Bicuspid valve, rheumatic fever, infective endocarditis
SLE, Marfan’s, advanced syphilis, ankylosing spondylitis, aortic dissection
Low diastolic pressure
Early diastolic, soft S1, not well transmitted to carotids

Question 9

Mitral stenosis

Answer 9

Pulmonary hypertension
Rheumatic fever, calcification, SLE, rheumatoid arthritis, carcinoid syndrome, infective endocarditis
SoB on exertion, orthopnoea, paroxysmal nocturnal dyspnoea
AF, systemic emboli, haemoptysis
Mid-late diastolic murmur

Question 10

Mitral regurgitation

Answer 10

Primary- degenerative valvular disease, infective endocarditis
Secondary- Distortion of LV
Pulmonary oedema
Pansystolic murmur