Heart Murmurs
Heart murmurs — Year 4 Internal Medicine (Cardiovascular) Notes
What our notes say
- Heart murmurs — Year 4 Internal Medicine (Cardiovascular) Notes (Heart murmurs)
- He has a heart murmur, palpable spleen tip, and splinter hemorrhages of fingernails. (CARDIOVASCULAR PATHOLOGY — Past Paper Questions & Answers)
- 26-year-old man, 2 days of high fever, heart murmur, echocardiography shows destruction of the aortic valve by large irregular vegetations, *S. aureus* bacteremia; develops LUQ pain, and abdominal CT shows a wedge-shaped 1.5x3cm splenic lesion with base on the capsule. (General Pathology MCQs: Fixatives, FNA, Endocrine & ARDS)
Study material on Heart Murmurs
Practice questions on Heart Murmurs
A 1-month-old infant has failure to thrive. On examination a heart murmur is auscultated over the chest. No cyanosis is noted. Echocardiography shows a left-to-right shunt just above the muscular interventricular septum. An abnormality of which of the following structures most likely produced this infant's defect?
- Chordae tendineae
- Crista terminalis
- Endocardial cushion
- Septum primum
- Sinus venosus
Answer: C. The endocardial cushions contribute to the atrioventricular valves and the septae,including the membranous portion of the interventricular septum. This is the most common form of ventricular septal defect (VSD), which is the most common heart defect in liveborns. ---
A 35-year-old delirious man with fever 39.3°C, BP 70/palpable, a heart murmur, palpable spleen, and splinter hemorrhages is brought to the ED. Most likely lab finding?
- Positive urine screen for opiates
- Elevated anti-streptolysin O
- Increased urinary free catecholamines
- Elevated Coxsackie B viral titer
Answer: A. The clinical picture is acute infective endocarditis. IV drug use is the major risk factor; positive opiate urine screen would confirm this predisposing condition. ---
A neonate has tetany, a heart murmur, serum calcium of 6.3 mg/dL, and a VSD. Over the first year he develops Pneumocystis, Aspergillus, and viral upper respiratory infections. Most likely explanation?
- 22q- chromosome deletion
- Abnormal Wiskott-Aldrich syndrome protein
- Defect in NADPH oxidase
- Failure of B cell maturation into plasma cells
Answer: A. Hypocalcemia (absent parathyroids) + cardiac defects + T-cell deficiency causing fungal and viral infections = DiGeorge syndrome. Chromosome 22q11 deletion causes failure of 3rd and 4th pharyngeal pouch development → absent thymus and parathyroids. ---