Murmurs

Question 1

What type of murmur is characterized by being louder on expiration?

Answer 1

Ejection systolic

This includes murmurs associated with aortic stenosis and hypertrophic obstructive cardiomyopathy.

Question 2

Which conditions are associated with an ejection systolic murmur?

Answer 2

• Aortic stenosis
• Hypertrophic obstructive cardiomyopathy

These conditions exhibit louder sounds during expiration.

Question 3

What type of murmur is characterized as holosystolic (pansystolic)?

Answer 3

Mitral/tricuspid regurgitation

This murmur is high-pitched and ‘blowing’ in character.

Question 4

How does tricuspid regurgitation differ from mitral regurgitation during respiration?

Answer 4

Tricuspid regurgitation becomes louder during inspiration

Increased venous blood flow into the right atrium and ventricle during inspiration enhances the stroke volume of the right ventricle.

Question 5

What is the character of the murmur associated with ventricular septal defect?

Answer 5

‘Harsh’ in character

This type of murmur is typically heard in ventricular septal defect.

Question 6

What type of murmur is associated with mitral valve prolapse?

Answer 6

Late systolic

This murmur occurs late in the systolic phase.

Question 7

What type of murmur is classified as early diastolic?

Answer 7

Aortic regurgitation

This murmur is high-pitched and ‘blowing’ in character.

Question 8

What is the character of the Graham-Steel murmur?

Answer 8

High-pitched and ‘blowing’ in character

This murmur is associated with pulmonary regurgitation.

Question 9

Which murmur is characterized as mid-late diastolic?

Answer 9

Mitral stenosis

This murmur has a ‘rumbling’ character.

Question 10

What is the Austin-Flint murmur associated with?

Answer 10

Severe aortic regurgitation

This murmur is also ‘rumbling’ in character.

Question 11

What type of murmur is described as continuous and machine-like?

Answer 11

Patent ductus arteriosus

This murmur has a distinctive continuous sound.

Question 12

Which side of the heart is a murmur heard best on inspiration?

Answer 12

Right-sided murmur

This is due to increased venous return during inspiration.

Question 13

Which side of the heart is a murmur heard best on expiration?

Answer 13

Left-sided murmur

This is typically the case for left-sided heart conditions.

Question 14

What increases sound of ejection systolic murmur?

Answer 14

Mixed aortic valve disease
Expiration
Anaemia and thyrotoxicosis: faster heart rate

Question 15

What decreases sound of ejection systolic murmur?

Question 16

What causes ejection systolic murmur on inspiration?

Answer 16

Atrial septal defect

Question 17

What is a still’s murmur?

Answer 17

Quiet systolic murmur heard in young children that disappears

Question 18

What causes a mid systolic murmur greater on expiration?

Answer 18

Mitral valve prolapse

Question 19

What cases pansystolic murmur at left sternal edge?

Answer 19

Tricuspid regurgitation, associated with pulmonary stenosis like COPD

Question 20

What causes mitral valve prolapse?

Answer 20

Marfan’s syndrome
Ehler’s danlos syndrome

Question 21

Which murmurs are sseee in Marfan’s?

Answer 21

Aortic regurg
Mitral prolapse

Question 22

Which meme oxxuea with pulmonary stenosis?

Answer 22

Ejection systolic

Question 23

What is the murmur type in mitral stenosis

Answer 23

Mitral stenosis is characterized by a low-pitched, diastolic rumble at the apex with an opening snap

Question 24

What does pulsatile hepatomegaly indicate?

Answer 24

Tricuspid regurg

Question 25

What is a normal physiological extra heart sound?

Answer 25

S3 if under 30 years old

Question 26

What causes S3 heart sound?

Answer 26

Rapid diastolic filling of ventircle heard in: Dilated cardiomyoapthy Constrictive pericarditis Mitral regurgitation

Question 27

What causes S4 heart sound?

Answer 27

Stiffness of ventircle from atria contraction due to: Aortic stenosis Hypertension HOCM

Question 28

What does S4 coincide with?

Answer 28

P wave

Question 29

What causes a slow rising pulse?

Answer 29

Aortic stenosis

Question 30

What causes systolic murmur in 4th intercostal left parasternal region?

Answer 30

Tricuspid regurgitation, which is louder during inspiration. Patient will have signs of cor pulmonale

Question 31

How are ejection systolic murmurs accentuated?

Answer 31

Louder on expiration

Question 32

What causes cannon A wave?

Answer 32

Ventricles contracting against a closed AV valve, sending pressure wave up the jugular vein -> seen in complete heart block and PE

Question 33

What murmur is assoicated with haemoptysis?

Answer 33

Mitral stenosis

Question 34

What are the features of mitral stenosis?

Answer 34

rumbling mid-diastolic murmur heard loudest over the apex. The murmur louder during expiration

Question 35

What causes a pan systolic murmur loudest at the left sternal edge at the 4th intercostal space?

Answer 35

Tricuspid regurgitation

Question 36

How to differentiate between tricuspid and mitral regurgitation?

Answer 36

Both have pan-systolic murmur,over the left lower sternal edge. Mitral will increase with expiration/ tricuspid increases with expiration

Question 37

How to manage symptomatic mitral stenosis?

Answer 37

Percutaneous mitral commisurotomy for patients with a valve area over 1cm. This procedure involves introducing a balloon catheter through the femoral vein, advancing it across the atrial septum to the mitral valve, and inflating it to split the fused commissures

Question 38

What is Percutaneous mitral commisurotomy best for?

Answer 38

Young patients with non calcified mitral valve and minimal subvlavular diseas

Question 39

What is the preferred amangement of symptomatic mitral stenosis in older patients?

Answer 39

Mitral valve replacement with a bioprosthetic valve, which avoids need for anticoagulation

Question 40

What indicates a patient is suitable for balloon mitral valvuloplasty?

Answer 40

Opening snap which correlates with the sudden contraction of the valve leaflets after their initial opening

Question 41

What causes loud S1 in mitral stenosis!

Answer 41

high pressure on the left side of the heart keeping the mitral valve open

Question 42

What causes a quiet S1 in mitral stenosis?

Answer 42

severe mitral valve stenosis as the intensity of S1 is reduced if the valve is thickened.

Question 43

Which murmur is a systolic murmur, loudest in the second intercostal space, along the left sternal border?

Answer 43

Pulmonary stenosis