Cardiology Question 3 Instructor

What is the differential diagnosis of continuous thoracic murmurs and their origin?

In the order of descending frequency…

Diagnosis Key findings
Cervical venous hum Maximal in R supraclavicular fossa & can radiate to contralateral area or below clavicle. Disappears on compression of jugular vein.
Hepatic venous hum Often disappears with epigastric pressure
Mammary souffle Disappears upon pressing hard with stethoscope, or patient moving into upright position
Patent ductus arteriosus (Gibson’s murmur) Loudest at the 2nd left ICS. Machinery murmur.
Coronary arteriovenous fistula Loudest at the lower sternal border.
Ruptured aneurysm of sinus of Valsalva Loudest at the upper right sternal border, sudden onset
Bronchial collaterals Associated signs of congenital heart disease
High grade coarctation Brachial/pedal arterial pressure gradient
Anomalous left coronary artery arising from pulmonary artery
Anomalous pulmonary artery arising from aorta
Pulmonary artery branch stenosis Heard outside the area of cardiac dullness
Pulmonary AV fistulas Heard outside the area of cardiac dullness
ASD with mitral stenosis or atresia Altered by Valsalva manoeuvre
Aortic-arterial fistulas
Superior caval syndrome due to syphilitic aneurysmal dilatation of aortic root and mediastinitis Systolic accentuation; 2nd and 3rd right ICS

Sapira led. p.304

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