Quiz 17 Continuous Murmur

Front 1

A 15 year-old girl admitted with dyspnoea has a continuous murmur best heard at 2nd left inter-costal space and conducted along the clavicle. This is accompanied by a constant thrill. There is a late systolic accentuation for the continuous murmur. Multiple clicks are also heard.

Back 1

Persistant Ductus Arteriosis

Front 2

This 45 year old man came with history of sudden onset of severe tearing type of chest pain along left side of sternum, following lifting up of a heavy log of wood. Examination showed bounding pulse and a superficial continuous thrill & murmur best elicited over left sternal edge.

Back 2

Rupture of Sinus Of Valsala Aneurysm

Front 3

A one year old infant was found to have a continuous murmur over precordium. While investigating this, ECG of the child surprisingly showed classical changes of acute anterior wall myocardial infarction. The child was subjected to a coronary artery bypass with internal mammary artery graft.

Back 3

Anomalous Origin of Left Coronary Artery from Pulmonary Artery (ALCAPA)

Front 4

In this 45 year-old man a faint continuous murmur was heard along the left sternal edge and left ventricular apex. The diastolic component was louder. Subsequently the murmur disappeared and the ECG showed changes of myocardial infarction. Coronary angiography was diagnostic.

Back 4

Coronary Arteriovenous Fistula

Front 5

In this 35 year-old woman there is a pulsatile mass over the upper limb. A continuous bruit is heard over the swelling. There is edema, varicosity, and pigmentation of the skin distal to the swelling. Compression of the swelling caused reflux slowing of the heart rate.

Back 5

Systemic Arteriovenous Fistula

Front 6

In this 75 year-old man with history of bone pains and vertigo, there is enlargement of the skull, bowing of the right tibia, which is warmer than the other and a continuous murmur is heard in the upper part of the thigh. There is also evidence of bounding pulses and high output cardiac failure.

Back 6

Paget's Disease

Front 7

This 35 year-old patient was admitted with clinical features of uremia and diagnosed to have chronic renal failure. He was subjected to a minor surgical procedure in the thigh and there after on auscultation a continuous murmur was heard over the upper part of the thigh.

Back 7

Iatrogenic Arteriovenous Fistula

Front 8

This 1 year-old infant was having a continuous murmur over the mid sternal region which was maximally heard during late systole. The pulmonary component of the second sound was accentuated and the diastolic part of the murmur was brief. Central cyanosis was evident.

Back 8

Aortopulmonary Fistula

Front 9

This 15 year-old boy has a grade V/VI pansystolic murmur, continuing as an early diastolic murmur was heard in the third and fourth intercostal space along the left sternal edge. The wide pulse pressure due to very high systolic and very low diastolic blood pressure was highly suggestive of diagnosis.

Back 9

Ventricular Septal Defect with Aortic Regurgitation

Front 10

This patient has evidence of a continuous murmur over the left side of precordium. At the same time he has a wide and fixed split second sound and a opening snap heard in early diastole, mid-diastolic rumbling murmur best heard in the mitral area with presystolic accentuation.

Back 10

ASD with Rheumatic MS

Leutem Bacher Syndrome

Front 11

This 35 year-old woman has cardiomegaly, outward and downward shift of the apex, which is forceful in character and a murmur over the aortic areas which appear to be continuous in the sitting up and leaning forward position. The systolic part of the murmur is also conducted to the carotids.

Back 11

Aortic Stenosis + Aortic Regurgitation

Front 12

A 25 year-old man has continuous murmurs heard over the lateral walls of the chest. Tortuous blood vessels are seen over backand sides of chest. Weak and delayed lower limb pulses and isolated upper extremity hypertension are present. Upper limbs were better developed than the lower.

Back 12

Coarctation of Aorta

Front 13

This 5 year-old child has breathlessness and cyanosis on exertion which is relieved to some extent by squatting. Examination shows a prominent LPH, single component second sound and a short ESM in the pulmonary area. In addition the child has continuous murmurs over the sides of chest.

Back 13

Fallot with broncho-pulmonary anastomosis

Front 14

This 15 year-old child underwent a cardiac surgery at the age of five for complaints of severe breathlessness & central cyanosis. On examination there are weak left upper limb pulses, LPH, systolic thrill and an ESM in pulmonary area. There is a continuous murmur heard over the left side of chest.

Back 14

Blalock Taussig Shunt

Front 15

This 25 year-old lactating mother was complaining of severe chest pain and was detected to have a continuous heart murmur over the left of precordium. Firm pressure with the diaphragm of the stethoscope eliminated the diastolic portion of the murmur.

Back 15

Mammary Souffle

Front 16

In this young man aged 25 years, a continuous murmur is audible in the medial part of right supra-clavicular fossa especially in the upright posture. It is abolished instantaneously by digital compression of the internal jugular vein. The murmur is reduced in intensity in the lying posture.

Back 16

Venous Hum

Front 17

In this 45 year-old chronic alcoholic patient a continuous murmur is heard only in the epigatrium and around the umbilicus. On examination there is edema, hepatomegaly, splenomegaly and ascites. There is palmar erythema and spider naevi over the upper chest.

Back 17

Caput Medusae