A 25-year-old woman is noticed to have a murmur during pregn

Murmurs

A Apical mid-diastolic murmur
B Apical pan-systolic murmur
C Apical late systolic murmur
D Pan-systolic murmur at lower left sternal edge
E Early diastolic murmur at left sternal edge
F Ejection systolic murmur over pulmonary area
G Ejection systolic murmur over sternal edge, non-conducted
H Ejection systolic murmur over aortic area, conducted to neck

Identify the murmur that you would expect to hear in each patient:

A 25-year-old woman is noticed to have a murmur during pregnancy, which is still present six months after she has delivered. There is no past medical history. There is a mild parasternal lift. The chest X-ray shows a normal heart size, but there is pulmonary plethora.

A 61-year-old woman has been taking warfarin since she had a stroke at the age of 52 years, from which she has made a good recovery. She is in New York Heart Class 2. She has a parasternal lift, and a loud first heart sound. The chest X-ray shows left atrial enlargement.

A 47-year-old man has been unwell for five months, with lethargy, weight loss and night sweats. For one week he has been breathless when lying flat. The apical impulse is displaced and forceful, his blood pressure is 150/60 mmHg, and he has a collapsing pulse. The chest X-ray shows an enlarged heart with upper lobe venous diversion.

A 74-year-old man has a 3-month history of breathlessness and central chest pain on exertion. He has had one episode of syncope while carrying shopping.

A 67-year-old woman, who had a mitral valve replacement 8 years ago, complains of a recurrence of breathlessness on exertion over the past year. She also has abdominal discomfort. The jugular venous pressure is elevated. The chest X-ray shows a prominent main pulmonary artery and clear lung fields.

Answers:
Pan-systolic murmur at lower left sternal edge
Apical mid-diastolic murmur
Early diastolic murmur at left sternal edge
Ejection systolic murmur over aortic area, conducted to neck
Pan-systolic murmur at lower left sternal edge

The first case would suggest a VSD (the pulmonary plethora and parasternal heave suggest this more so than ASD) and a systolic murmur over the 4th ICS may be audible. The second case has mitral stenosis and a mid diastolic murmur would be expected. The third case has features of aortic regurgitation and hence an early diastolic murmur would be expected. The fourth case of chest pain, dyspnoea and syncope in an elderly male suggests aortic stenosis with an ejection systolic murmur expected. The final case has features of a tricuspid regurgitation and hence a pan-systolic murmur over the left sternal edge is expected.