19: Cardiac Sounds And Murmurs

Question 1

Seven phases of the cardiac cycle

Answer 1

1. Atrial contraction
2. Isovolumetric contraction
3. Rapid ejection
4. Reduced ejection
5. Isovolumetric relaxation
6. Rapid filling
7. Reduced filling

Question 2

Valves on the right vs left side of the heart

Answer 2

Right: tricuspid, pulmonic
Left: bicuspid, aortic

Question 3

Which two valves are low pressure and which two are high pressure systems?

Answer 3

Low pressure: right sided valves

High pressure: left sided valves

Question 4

At what phase in the cardiac cycle does S2 occur?

Answer 4

End of systole

Question 5

Five important auscultation locations and what is being heard there ***

Answer 5

1. Right 2nd ICS: aortic valve
2. Left 2nd ICS: pulmonic valve
3. 3rd ICS: Erb’s point
4. Left 4th ICS: tricuspid valve
5. Left 5th ICS: mitral valve

Question 6

Murmur

Answer 6

Vibratory sound produced when the flow of blood through a valve is turbulent or disrupted

Question 7

When is a murmur concerning

Answer 7

When associated with symptoms

Question 8

Three questions to ask yourself during auscultating a murmur

Answer 8

1. Location - which valve am i listening to?
2. Timing: diastolic or systolic
3. Shape - does it change in intensity?

Question 9

Good position to listen for an aortic regurgitation

Answer 9

Pt leaning forward

Question 10

Good position to listen for a mitral stenosis

Answer 10

Left lateral decubitus

Question 11

Grading a systolic murmur: scale

Answer 11

1. very faint
2. Equal in volume to S1/S2
3. Louder than S1 and S2
4. Louder with a palpable thrill
5. Louder with a thrill, heard with stethoscope partly off chest
6. Loudest, can be heard without stethoscope

Question 12

Four types of systolic murmurs

Answer 12

1. Aortic and pulmonary stenosis

2. Tricuspid and mitral regurgitation

Question 13

Four types of diastolic murmurs

Answer 13

1. Tricuspid and mitral stenosis

2. Pulmonic and aortic regurgitation

Question 14

Grading diastolic murmurs

Answer 14

1/4: barely audible
2/4: faint but immediately audible
3/4: easily heard
4/4: very loud

Question 15

How does increased preload decrease aortic murmur in HOCM?

Answer 15

Pushes septum away from aortic outflow track -> blood can be more easily ejected

Question 16

How does increased preload improve MVP murmur

Answer 16

Allows prolapsed leaflets to return to normal orientation

Question 17

Three low yield murmurs to be aware of

Answer 17

Atrial septal defect, ventricular septal defect, patent ductus arteriosus

Question 18

Valsava phase and movement that correlates with increased preload and afterload

Answer 18

Valsava release phase, squatting -> increase in preload and afterload

Question 19

Two murmurs that are crescendo-decrescendo

Answer 19

Aortic stenosis, HOCM

Question 20

Two murmurs that are holosystolic

Answer 20

Tricuspid and mitral regurgitation

Question 21

Opening snap murmur vs mid-systolic click

Answer 21

Opening snap: mitral stenosis

Mid-systolic click: mitral valve prolapse

Question 22

Murmur that is early blowing diastolic murmur

Answer 22

Aortic regurg

Question 23

Associated conditions for aortic stenosis

Answer 23

SAD: syncope, angina, dyspnea

Question 24

Murmur associated with IV drug use

Answer 24

Tricuspid regurg

Question 25

Two murmurs associated with rheumatic fever

Answer 25

Mitral regurg + stenosis

Question 26

Disorder associated with aortic regurgitation

Answer 26

CT disorders like Marfan’s