Question 3.2

List 4 causes of a mid diastolic murmur over the apex.

[Click here to toggle visibility of the answers]

College Answer

Mitral stenosis
Aortic regurgitation
Left to right shunts – VSD or a PDA 
Severe MR
Acute rheumatic fever


Unlike the very similar question 26.3 from the second 2011 paper, this specifically asks for MID-diastolic murmurs.

Interestingly, this college answer is quite differently worded.

Instead of naming the eponymous Carey Coombs murmur of mitral incompetence in acute rheumatic fever, they just call it "acute rheumatic fever".

In any case, its essentially the same question. Candidates will do well to make themselves intimately familiar with murmurs, where they arise, and at which stage of the cardiac cycle one can expect to hear them.


Clinical Examination of the Critically Ill Patient, 3rd edition by L.I.G. Worthley - which can be ordered from our college here.

Clinical Examination: whatever edition, by Talley and O'Connor. Can be acquired any damn where