QuestionSBA
QuestionChoice
This is a reasonable differential for a systolic murmur, however, there are no mentions of other symptoms (syncope, angina, dyspnoea) or radiation to the carotid region. Further, aortic stenosis is more common in older patients. A flow murmur is the most likely diagnosis, exacerbated by the anaemia.
10035378
b
Aortic stenosis
QuestionChoice
This is a reasonable differential for a systolic murmur, however a flow murmur is most likely given the patient is young and anaemic. Mitral regurgitation is more common in older patients, unless there are risk factors for valvular disease (e.g. congenital abnormalities/rheumatic fever).
10035380
d
Mitral regurgitation
QuestionChoice
This is a reasonable differential for a systolic murmur, however this is more common in older patients, and the murmur radiates to the carotid arteries. A flow murmur is the most likely diagnosis, exacerbated by the anaemia.
10035379
c
Aortic sclerosis
QuestionChoice
This is a reasonable differential for a systolic murmur, however a flow murmur is most likely given the patient is young and anaemic. Further, they have no risk factors for valvular disease or tricuspid regurgitation (e.g. pulmonary hypertension).
10035381
e
Tricuspid regurgitation
QuestionChoice
Soft, systolic, asymptomatic murmurs in young patients are often due to high flow across valves and vessels. These can be exaggerated when circulation is hyperdynamic (e.g. due to anaemia, which this patient has). An echocardiogram should be carried out to exclude structural/valvular pathology.
10035377
a
Anaemia
Concept
Chapter
2693
6128
Ejection systolic murmurs
Topic
134
Cardiology
19479
Anaemia can cause a soft, systolic murmur due to increased blood flow across heart valves in a hyperdynamic circulation.
A 24-year-old woman visits her GP with severe menorrhagia, which she has suffered from for a number of years. She feels tired all the time and is considering starting the combined oral contraceptive pill to help with her symptoms.


She has no other past medical history.


On examination, she looks pale. Her abdomen is soft and non-tender, and she declines a vaginal examination. Her chest is clear. A soft, non-radiating systolic murmur is heard on auscultation.


Blood results:

||||
|--------------|:-------:|---------------|
|Haemoglobin|90 g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|9.2x10<sup>9</sup>/L|3.0 - 10.0|
|Mean Cell Volume (MCV)|72 fL|80 - 96|


Which of the following is most likely causing her murmur?

 
a