1. SYSTOLIC MURMUR QUIZ Dr. S. Aswini Kumar. MD. 1. This 45 year-old man has an acute onset early systolic murmur which begins with S1 and extends for a variable period but ending well before S2. It is decrescendo in configuration and best heard just medial to the apical impulse. The murmur is also associated with a precordial thrill.2. This 35 year-old female has a mid-systolic murmur beginning at a short interval after S1, and ending before S2, crescendo-decrescendo in configuration. Loudest in the second right inter-costal space and radiating along the carotid, a systolic thrill and systolic ejection click.3. This 85 year-old man has a mid-systolic murmur beginning at a short interval following S1, and ending before S2, It is crescendo-decrescendo in configuration, loudest in the second right IC space and radiating along carotid arteries, but no systolic thrill or ejection click is heard. 4. 25 year-old woman has a mid-systolic murmur introduced by an ejection click, which is best heard in the 2nd left inter-costal space of grade 5/6 intensity. It is also crescendo-decrescendo in it’s configuration, with radiation to clavicle, LPH and soft pulmonary second sound. 5. This mid-systolic murmur is loudest between left sternal edge and apex, of grade III / VI, crescendo-decrescendo in configuration. It does not radiate into the neck. The intensity increases with standing and decreases with squatting. The carotid pulse is brisk and bifid.6. A late systolic murmur beginning well after the onset of ejection and best heard between the apex and the left sternal edge. It is introduced by a non-ejection click. Click and murmur move closer to S1 on standing & valsalva and move oppositely on squatting.7. This murmur begins with S1 and continue through systole to S2. The murmur is loudest at mitral area and conducted to the axilla and back. It is associated with a systolic thrill, a soft S3, and a short diastolic rumbling murmur best heard in the left lateral decubitus position.8. This holosystolic murmur is soft, and of grade III/VI intensity. It is loudest at the left lower sternal edge, & increases in intensity upon inspiration. Associated signs include prominent
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waves in the jugular venous pulse, hepatic pulsations, and peripheral edema9. This 15 year-old boy has a holosystolic murmur which is best heard at the left lower sternal edge, accompanied by a palpable thrill along the mid-left sternal border, It does not increase during inspiration nor there are accompanying signs of tricuspid regurgitation. 10. This 45 year-old woman has an ejection systolic murmur in the second left inter-costal space, normal M1 and T1 but abnormal P2 which has a constant relationship with A2. The murmur itself was unaccompanied by any click and unassociated with any conduction. 11. The ejection systolic murmur in this 85 year-old woman is unaccompanied by any thrills or sounds. It is best heard in the second left space and not having much of a conduction elsewhere. The intensity is grade II/VI. Left para-sternal heave was conspicuous by its absence.12. This child chronically ill since childhood and turning blue and breathless while he was playing, He has got a systolic murmur that is best heard at the third space on the left side, with a very soft pulmonary component of second sound, and presence of left para-sternal heave.13. This 75 year-old man has a systolic murmur in the aortic area, grade II / VI in intensity, ejection systolic in timing and soft in nature, No conduction. His pulse was 34 and BP was 180/80. No heave in the apex beat, no heave in the left para-sternal region. Irregular large waves were observed in the neck.14. This 35 year-old woman has a ejection systolic murmur best heard in the aortic area which is localized and not associated with a thrill or an ejection sound. The BP is very high systolic and low diastolic. The apex beat is forceful and displaced outside the usual position.15. A mid-systolic murmur over the anterior part of the chest, back, and spinous processes was heard in a 25 year old man with better developed upper limbs, when compared to the lower limbs. Additional systolic as well as continuous murmurs over the lateral thoracic wall.16. In this young girl, 15 years of age an ejection systolic murmur was heard loudest high in the neck, with selective radiation into the right carotid artery. She was mentally retarded, having a peculiar facies as well as multiple congenital developmental defects.17. A 45 year-old hypertensive patient came for vague chest discomfort. An ejection systolic murmur was heard on the right second space with conduction to the carotid but without any ejection click. The absence of pulses in the left upper limb was diagnostic.