Heart Murmurs

Question 1

Systolic murmurs

Answer 1

AS
PS
MR
TR
MVP

Question 2

Diastolic murmurs

Answer 2

AR
PR
MS
TS

Question 3

Describe how you grade a murmur

Answer 3

1 - heard only if you listen hard for ages
2 - faint but heard easily
3 - loud no thrill
4 - loud with thrill

Question 4

Describe the murmur of aortic stenosis

Answer 4

Opening click + ejection harsh systolic murmur

Question 5

Describe the murmur of pulmonary stenosis

Answer 5

Ejection systolic

Question 6

Describe the murmur of mitral regurgitation

Answer 6

Pansystolic

Question 7

Describe the murmur of tricuspid regurgitation

Answer 7

Pansystolic

Question 8

Describe the murmur of mitral valve prolapse

Answer 8

Mid systolic click + mid/late systolic murmur

Question 9

Aortic stenosis findings

Answer 9

Opening click + harsh ejection systolic murmur
Slow-rising small volume pulse, narrow pulse pressure
Displaced heaving apex beat if LVH
Systolic thrill in aortic area
Reduced/absent S2
Radiates to carotids

Question 10

Pulmonary stenosis findings

Answer 10

Ejection systolic murmur
Right-sided heart failure (RV heave, tricuspid regurgitation, raised JVP)
Widely split S2
Right ventricular dilation (right ventricular heave, peripheral signs of right heart failure)
Radiates to left shoulder/infraclavicular

Question 11

Aortic regurgitation findings

Answer 11

Decrescendo early diastolic murmur
Collapsing pulse, wide pulse pressure. Corrigan’s, Quincke’s, de-Musset’s
Displaced hyperdynamic apex beat
Radiates to left sternal edge

Question 12

Mitral stenosis findings

Answer 12

Opening snap + low pitched rumbling mid-diastolic murmur
Loud S1
Tapping apex beat
Low volume pulse
AF
Signs of pulmonary HTN (malar flush, right sternal heave, engorged neck veins)

Question 13

Describe the murmur of aortic regurgitation

Answer 13

Decrescendo early diastolic murmur

Question 14

Describe the murmur of pulmonary regurgitation

Answer 14

Early decrescendo diastolic murmur

Question 15

Describe the murmur of mitral stenosis

Answer 15

Opening snap + low pitch rumbling mid-diastolic murmur

Question 16

Describe the murmur of tricuspid stenosis

Answer 16

Mid-diastolic

Question 17

Getting a patient to sit forward and hold expiration exaggerates which murmur?

Answer 17

Aortic stenosis

Question 18

Getting a patient to lie on their left and hold expiration exaggerates which murmur?

Answer 18

Mitral regurgitation