14. Cardiac Cycle and Sounds II

Question 1

Generally speaking, what does an increase in preload and afterload do to murmurs?

Answer 1

Makes them louder

Question 2

What are the two diseases where murmurs are made quieter by increased afterload?

Answer 2

Mitral Valve Prolapse (MVP)

Hypertrophic Obstructive Cardiomyopathy (HOCM)

Question 3

Do murmurs of the right heart get louder or softer with inspiration

Answer 3

Louder

(Rinspiration)

Question 4

What should you expect if you hear a “crescendo - decrescendo” murmur?

Answer 4

Aortic Stenosis

Question 5

What is the typical presentation for aortic stenosis?

Answer 5

Old-SAD

Old

Syncope

Angina

Dyspnea

Question 6

What is the effect of the valsalva maneuver on preload?

Answer 6

Valsalva maneuver decreases preload by increasing interthoracic pressure.

Question 7

What is the effect of squatting on afterload?

Answer 7

Squatting increases afterload

Question 8

What heart issue might you expect if you hear a murmur in someone with a history of rheumatic fever?

Where should you auscultate to hear it?

Answer 8

Mitral valve regurgitation

5th intercostal - left midclavicular line

Question 9

If you hear a holosystolic murmur, what two structures might you be concerned about?

Answer 9

Tricuspid / Mitral valve

(Holosystolic murmurs are often related to tricuspid or mitral regurgitation)

Question 10

What disease may correpond to a murmur in a patient with a connective tissue disease?

Answer 10

Aortic regurgitation

Question 11

What is associated with an opening snap?

Answer 11

Mitral stenosis

Question 12

What heart sound is associated with myxomatous valvular disease?

Answer 12

Mitral Valve Prolapse