OSCEs and Heart Murmurs

By Joshua BowerPeer 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)

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

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

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

List FOUR important causes of AF

• IHD• Rheumatic heart disease• Thyrotoxicosis• Pneumonia• PE• Alcohol

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