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OSCEs and Heart Murmurs

OSCEs and Heart Murmurs. By Joshua Bower Peer Revision 2013/14. AS MR ARMS says…. AS – ejection systolic MR – pansystolic AR – early diastolic MS – mid-diastolic. What does this mean: I + II + O. Heart sounds I and II present O means no other sounds (i.e. no murmur).

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OSCEs and Heart Murmurs

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  1. OSCEs and Heart Murmurs By Joshua Bower Peer Revision 2013/14

  2. AS MR ARMS says… • AS – ejection systolic • MR – pansystolic • AR – early diastolic • MS – mid-diastolic

  3. What does this mean: I + II + O • Heart sounds I and II present • O means no other sounds (i.e. no murmur)

  4. What is the mechanism behind the 3rd heart sound? Give TWO differentials • Rapid ventricular filling • May be normal in <30yo • Think volume overload • CCF • MR • AR • Anterior MI

  5. What is the mechanism behind the 4th heart sound? Give TWO differentials • Due to poorly compliant ventricle • Never normal • Think pressure overload • AS • HTN • Post-MI fibrosis

  6. Give THREE differentials for an irregularly irregular pulse • AF • Ventricular ectopic beats • Complete heart block • To differentiate AF and VEBs without an ECG, get the patient to exercise – AF will remain but VEBs will be abolished

  7. List FOUR important causes of AF • IHD • Rheumatic heart disease • Thyrotoxicosis • Pneumonia • PE • Alcohol

  8. Sorry for the poor quality… if it’s unreadable send me a message and I’ll type it up (J.Bower@warwick.ac.uk)

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