Murmurs

Question 1

When will you hear a Decrescendo early diastolic murmur?

Answer 1

Aortic regurg

Question 2

Name signs that are associated with Aortic regurg?

Answer 2

Corrigan’s sign 
De Musset’s sign 
Quincke’s sign 
Duroziez’s sign
Traube’s sign 
Muller’s sign

Question 3

What is quincke’s sign?

Answer 3

pulsations are seen in the nail bed with each heartbeat when nail bed is lightly compressed

Question 4

Austin Flint murmur is a sign of?

Answer 4

severe aortic regurg

Question 5

What is corrigan’s sign?

Answer 5

visible distention and collapse of carotid arteries in the neck

Question 6

Where do you hear an austin flint murmur?
How is this site different to normal aortic regurg site?

What does it sound like?

Answer 6

low pitched rumbling mid-diastolic murmur heard best at the apex (as opposed to left sternal edge)

Question 7

What is de musset sign?

Answer 7

head bobbing with each heartbeat

Question 8

what is duroziez sign?

Answer 8

stethoscope placed over femoral arteries. When gentle pressure is applied proximal to the stethoscope a systolic murmur is heard;

Question 9

what is mullers sign?

Answer 9

Pistol shot’ sound heard when stethoscope placed over the femoral artery during systole and diastole

Question 10

what is traube sign?

Answer 10

Pistol shot’ sound heard when stethoscope placed over the femoral artery during systole and diastole

Question 11

Low-volume pulse which may be irregularly, irregular is common in which valvular disorder?

therefore which condition is common in this disorder?

Answer 11

mitral stenosis

Atrial fibrillation

Question 12

Which disorder do you see a Mid-systolic click

Followed by a mid or late-systolic murmur

Answer 12

Mitral valve prolapse

Question 13

which disorder do you see Large ‘v-waves’ in JVP

Answer 13

tricuspid regurg

Question 14

Name 4 signs of right heart failure

Answer 14

Right ventricular heave
Peripheral oedema
Hepatomegaly
Ascites

Question 15

Loud first heart sound with tapping apex beat is seen in what?

Answer 15

mitral stenosis

Question 16

Prominent ‘a waves’ in JVP is seen when?

meaning?

Answer 16

pulmonary stenosis

and less often in tricuspid stenosis

occur because there is resistance to rt atrial contraction

Question 17

What is the aetiology of a widely split S2 wave?

Answer 17

Widely split S2 – blood from the ventricles takes longer to pass through a narrow pulmonary valve, so pulmonary valve closure occurs much later than aortic valve closure

Question 18

Pulmonary stenosis can cause?

Which can lead to what signs?

Answer 18

Right ventricular dilatation thus;

Right ventricular heave
Tricuspid regurgitation
Peripheral signs of right-sided heart failure

Question 19

Which murmur is associated with pulmonary regurg and cor pulmonale?

Answer 19

Graham Steell murmur - early diastolic decrescendo high pitched murmur

it is called this (as opposed to just early diastolic) when associated with mitral stenosis

Question 20

you see Raised JVP with giant ‘a waves’ when?

Answer 20

tricuspid stenosis

Question 21

Signs of pulmonary htn?

Answer 21

malar flush

graham steel murmur

right sternal heave

Question 22

4 causes of tricuspid regurg

Answer 22

Right ventricular dilatation

Rheumatic fever

Infective endocarditis

Congenital e.g. atrial septal defect,

Question 23

4 causes of aortic regurg

Answer 23

Rheumatological disorders; SLE, Rheum arthritis

Infective endocarditis

Prosthetic aortic valve failure

Connective tissue disease (e.g. Marfan syndrome, Ehlers-Danlos syndrome)

Question 24

4 causes of mitral regurg

Answer 24

Infective endocarditis

Left ventricular dilatation

Mitral valve prolapse

Connective tissue disease

Question 25

2 causes of aortic stenosis?

Answer 25

Degenerative age-related calcification (commonest cause) Bicuspid aortic valve (important cause in a young person with aortic steno

Question 26

4 causes of mitral stenosis? what is the most common cause?

Answer 26

Rheumatic heart disease (commonest cause of mitral stenosis worldwide) Congenital Left atrial myxoma (bening tumour on atrial septum) Connective tissue disorders; marfans, ehlers danlos

Question 27

2 causes of pulmonary stenosis?

Answer 27

Congenital; Turner’s | Rheumatic fever

Question 28

Mmemonic for the 3rd heart sound? What is the cause? When does S3 come?

Answer 28

Kentucky Rapid ventricular filling After s2 (1, 23)

Question 29

Mmemonic for the 4th heart sound? What is the cause? When does S4 come?

Answer 29

Tennessee Atrium contracting against a stiff ventricle (due to htn) Just before S1 (4, 12)

Question 30

What is a summation gallop / gallop rhythm? When do you hear it? Sound?

Answer 30

When both 3rd and 4th heart sounds are present End stage heart failure Sound; 4, 123

Question 31

Intrathoric pressure drops on inspiration, what else is supposed to drop? If this doesnt drop but rises instead, what is this sign called?

Answer 31

JVP Kussmaul's sign

Question 32

In which conditions do we see Kussmaul's sign and why?

Answer 32

1. Constrictive pericarditis 2. restrictive cardiomyopathy 3. cardiac tamponade because these limit right ventricular filling due to exerting pressure

Question 33

What is the mmemonic for causes of raised jvp?

Answer 33

PQRST

Question 34

What does PQRST stand for? - in relation to raised jvp

Answer 34

P-Pericardial effusion, Pulmonary embolism, Pulmonary hypertension (chronic) Q-Quantity of fluid (fluid overload) R-Right heart failure S-Superior venacaval obstruction - (distended veins without pulsation) T-Tricuspid regurgitation, Tricuspid stenosis, Tamponade (cardiac)

Question 35

Symptoms of Mitral stenosis?

Answer 35

SOB + palpitations Malar flush slow rising pulse Loud 1st HS +- an opening snap ECG: P mitrale - bifid p wave RVH Atrial fibrillation CXR: Smaller heart? pulmonary hypertension/ venous congestion?

Question 36

MX of Mitral stenosis?

Answer 36

Anticoagulation and treat AF In order; 1. Percutaneous mitral valvulostomy 2. Open mitral valvotomy - open surgery for heavily calcified valve 3. Replace valve with prosthesis

Question 37

Main sx of mitral regurg?

Answer 37

SOB ! PND, fatigue etc

Question 38

IVX findings of Mitral regurg?

Answer 38

ECG: SR/AF LVH CXR: Cardiomegaly pulmonary congestion/oedema

Question 39

Mx for mitral regurg?

Answer 39

Valvular Repair, Replacement, Clipping

Question 40

hope youve realised that elevated jvp is assocaited with which valvular issues?

Answer 40

right sided - tricuspid and pulmonary

Question 41

What are cannon waves or cannon a waves and their meaning?

Answer 41

cannon atrial waves, are waves seen occasionally in the jugular vein of humans with certain cardiac arrhythmias. When the atria and ventricles happen to contract simultaneously, the right atrium contracts against a closed tricuspid valve, resulting in back pressure into the venous system that can be seen in the jugular venous pulse as a high-amplitude "cannon wave" Not the same as "a waves"

Question 42

causes of cannon waves?

Answer 42

They occur irregularly in complete heart block and ventricular tachycardia,

Question 43

presentation of cannon waves?

Answer 43

may have also: headache, cough, and jaw pain arrythmia that lead to the cannon waves; palpitation and SOB - abrupt onset?