Test your knowledge of murmurs – but don’t worry, the video should help!
- Discuss the basic science relevant to valvular heart disease
- Outine the common aetiology of systolic and diastolic murmur
- Discuss the most common left and, and right, sided heart murmurs
Approach to the Patient with Heart Murmur
STEM 1 OF 4
A 77YOM presents with recurrent episodes of self-described "faints" and shortness of breath on exertion. His BP is 110/95 and his pulse feels slow to fill at the radial with some notable radio-radial delay.
Which sound is most likely to be absent on auscultation?
STEM 2 OF 4Select all the factors below that are most likely to have contributed to this patient's presentation
Group A streptococcus infection as a child
Cross-reactivity of myocytes to antibodies
Degeneration associated with age
Deposition of calcium within the leaflets
A connective tissue disorder
STEM 3 OF 4Which singular test would best confirm the diagnosis in this patient?
STEM 4 OF 4Assuming no other risk factors, what is the management of this patient?
Surgical valve replacement
Two types of valve replacement: aortic valve replacement (AVR) or, for older, higher-risk patients, transcatheter aortic valve implantation (TAVI).
Asymptomatic patients need regular follow-up.
Source: BMJ Best Practice.
STEM 1 OF 6
A middle-aged female presents with chronic cough, shortness of breath that is progressing and pain exacerbated with inhalation. On examination, bilateral lung base crackles are heard and JVP is slightly raised. A diastolic murmur is heard within the left axilla.
What is the patient's most likely diagnosis?
STEM 2 OF 6The patient's pulmonary capillary wedge pressure is raised significantly. What is the direct cause of this?
Right atrial hypertrophy
Right ventricular dilation
Left atrial hypertrophy
Left ventricular dilation
Right atrial dilation
Stem 3 of 6What is the most likely cause of this patient's condition?
Group A Streptococcus
Group B Streptococcus
STEM 4 OF 6Given the likely diagnosis above, what is the most common ECG finding you would expect?
Bifid P wave
PR internval contraction
Tented T waves
STEM 5 OF 6How is the timing of the murmur described?
Stem 5 of 6The patient is deemed to have severe symptomatic disease after echocardiography. What is the first line management in this patient?
Surgical valvular replacement
Further information: The patient is known to be normotensive with no history of stroke, diabetes or cardio-vascular disease.
Given this further information, what would you add to their long term management?