Abnormal Heart Sounds

Question 1

What creates the S1 heart sound?

Answer 1

Closure of the TV and MV

Question 2

What creates the S2 heart sound?

Answer 2

Closure of the AV and PV

Question 3

The pneumonic Kent-Tuck-Y is associated with which heart sound?

Answer 3

S3 (S1-S2-S3)

Question 4

What is the S3 heart sound associated with in adults?

Answer 4

Ventricular failure (ventricular gallop)

Question 5

The pneumonic Ten-Nes-See is associated with which heart sound?

Answer 5

S4 (S4-S1-S2)

Question 6

What is the s4 heart sound associated with?

Answer 6

Forceful atrial contraction against a stiffened, low compliant ventricle (atrial gallop)

Question 7

What are the defects that create a systolic murmur?

Answer 7

MR (MVP)/TR
AS/PS
VSD
AP shunts

Question 8

What are the defects that create a diastolic murmur?

Answer 8

AR/PR
MS/TS
Atrial myxoma

Question 9

What are the Sx’s of MR/MVP?

Answer 9

Fatigue, DOE, Orthopnea

Question 10

What are the murmur characteristics of MR/MVP?

Answer 10

Prominent at apex, radiates to L axilla

Question 11

What are the Sx’s of TR?

Answer 11

Prominent V wave in JVP

Question 12

What are the murmur characteristics of TR?

Answer 12

Blowing murmur increasing with inspiration (Carvallo’s sign)

Question 13

What is TR associated with?

Answer 13

Pulmonary HTN

Inferior MI/RV infarct

Question 14

What are the Sx’s of AS?

Answer 14

DOE, angina, syncope, heart failure, 60’s yo, parvis, tardis

Question 15

What are the murmur characteristics of AS?

Answer 15

Radiates into suprasternal notch/carotid as., Gallavardin phenomenon (radiates to apex to mimic MR)

Question 16

What are Parvis and Tardis?

Answer 16

Parvis = weak peripheral pulses
Tardis = delayed upstroke of carotid as.

Question 17

What are the Sx’s of PS?

Answer 17

Angina, syncope

Question 18

What are the murmur characteristics of PS?

Answer 18

Radiates to L shoulder and increases with inspiration (Carvallo’s sign)

Question 19

What is PS associated with?

Answer 19

TOF, TGA

Question 20

What are the characteristics of TOF?

Answer 20

PS, VSD, RVH, overriding aorta

Question 21

What is PR associated with?

Answer 21

Pulmonary HTN

Question 22

What are the murmur characteristics of PR?

Answer 22

Blowing murmur called “Graham Steell” murmur

Question 23

What are the Sx’s of MS?

Answer 23

DOE, orthopnea, cough, Ortner syndrome

Question 24

What are the PE findings of MS?

Answer 24

Blue facies, murmur after S2

Question 25

What is Ortner syndrome?

Answer 25

Hoarseness due to compression of the LRLN by L atrium

Question 26

What are the Sx's of TS?

Answer 26

Prominent A wave in JVP, ascites, hepatomegaly

Question 27

What are the murmur characteristics of TS?

Answer 27

Increases with inspiration (Carvallo's sign) and decreases with expiration and valsalva

Question 28

What are the PE findings of AR?

Answer 28

``` Wide pulse pressure De Musset sign Corrigan's pulse Quincke's pulse Traube's sign Durozrey's sign Hill's sign Bisferious pulse ```

Question 29

What is a Wide pulse pressure?

Answer 29

Larger difference between SBP and DBP

Question 30

What is De Musset sign?

Answer 30

Head will bob during diastole

Question 31

What is Corrigan's pulse?

Answer 31

Rapid upstroke of pulse

Question 32

What is Quincke's pulse?

Answer 32

Alternating blanching and flushing of skin

Question 33

What is Traube's sign?

Answer 33

Pistol shot sound over artery

Question 34

What is Durozrey's sign?

Answer 34

To and fro murmur over femoral a.

Question 35

What is Hill's sign?

Answer 35

BP higher in LE than UE

Question 36

What is a Bisferious pulse?

Answer 36

Pulse with double peak

Question 37

What is an Austin Flint murmur?

Answer 37

If AR has strong enough flow to hit mitral valve, the MV can't open and MS murmur is mimicked

Question 38

What type of murmur is an AR?

Answer 38

Diastolic decrescendo murmur