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Heart sounds, pulses & murmurs flashcards

12 high-yield MRCP Part 1 cards from the Intellect Medicos Cardiology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.

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1. Which valve lesion classically causes a slow-rising, low-volume pulse?

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   Aortic stenosis.

   Why? The narrowed valve limits how quickly blood can be ejected, so the pressure wave rises slowly and peaks late, with a small stroke volume.

2. In aortic stenosis, what is the classic character of the carotid pulse?

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   Slow-rising (anacrotic) and low-volume.

   Why? The narrowed valve limits how quickly blood can be ejected, so the pressure wave rises slowly and peaks late, with a small stroke volume.

3. In which part of the cardiac cycle does a third heart sound (S3) occur?

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   Early diastole, just after S2, during rapid passive filling of the ventricles.

   Why? Blood rushing into a compliant or volume-overloaded ventricle makes the ventricular wall vibrate. S3 can be normal in young people, athletes and pregnancy; in older adults it suggests heart failure or volume overload.

4. A 22-year-old footballer has an ejection systolic murmur at the left sternal edge. It gets louder when he stands up from squatting and quieter when he squats. What is the most likely diagnosis?

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   Hypertrophic obstructive cardiomyopathy (HOCM).

   Why? Standing reduces venous return, so the left ventricle is smaller and the thickened septum and mitral leaflet obstruct the outflow tract more. Squatting increases preload and afterload, enlarging the cavity and softening the murmur.

5. Which heart sound signals reduced ventricular compliance and cannot occur in atrial fibrillation?

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   S4 (the atrial gallop).

   Why? S4 is produced by atrial contraction into a stiff, non-compliant ventricle just before S1. It is usually pathological. With no organised atrial contraction in AF, there is nothing to generate it.

6. What is pulsus paradoxus, and name the classic cardiac cause.

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   A fall in systolic BP of more than 10 mmHg on inspiration. Classic cause: cardiac tamponade.

   Why? In tamponade the ventricles share a fixed space. On inspiration the right ventricle fills more and bulges into the left, so left ventricular output and systolic pressure fall.

7. Alternating strong and weak pulse beats (pulsus alternans) indicate what?

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   Severe left ventricular systolic failure.

   Why? A failing ventricle cannot produce the same stroke volume on consecutive beats, so pulse strength alternates even though the rhythm is regular.

8. Irregular cannon a waves in the JVP suggest which rhythm?

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   Complete (third-degree) heart block.

   Why? The atria and ventricles beat independently. Whenever the right atrium happens to contract against a closed tricuspid valve, a large cannon wave appears.

9. Giant v waves in the JVP are the classic sign of ______.

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   tricuspid regurgitation

   Why? During ventricular systole, blood regurgitates through the incompetent tricuspid valve into the right atrium, producing a large v wave (and often a pulsatile liver).

10. Which murmurs are classically louder on inspiration, and why?

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    Right-sided murmurs (for example tricuspid regurgitation), because inspiration increases venous return to the right heart.

    Why? Inspiration lowers intrathoracic pressure, drawing more blood into the right heart. Expiration favours left-sided murmurs.

11. Which murmur is described as a continuous "machinery" murmur below the left clavicle?

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    Patent ductus arteriosus.

    Why? The aortic pressure exceeds pulmonary artery pressure throughout systole and diastole, so flow through the duct (and the murmur) is continuous.

12. In severe aortic regurgitation, a mid-diastolic rumble at the apex is called the ______ murmur.

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    Austin Flint

    Why? The regurgitant jet hits the anterior mitral leaflet and partially closes it during diastole, creating a functional mitral stenosis-like rumble.