Abnormal Heart Sounds

Question 1

When will you hear A₂ with increased intensity? P₂?

Answer 1

1. systemic HTN
2. pulmonary HTN, dilated pulmonary a., ASD

Question 2

When will you hear A₂ with decreased intensity or absent? P₂?

Answer 2

1. calcific aortic stenosis due to valve immobility
2. increased AP diameter of chest assoicated with aging; pulmonic stenosis

Question 3

What is the cause of wide splitting of S₂? fixed splitting? paradoxical or reversed splitting?

Answer 3

1. delayed closure of pulmonic valve or early closer of aortic valve
2. prolonged RV systole or RV failure
3. LBBB

Question 4

What are causes of left sided S₄?

Answer 4

• hypertensive HD
• AS
• ischemic and hypertrophic cardiomyopathy

Question 5

Tips to ID heart murmurs

Answer 5

Look for: timing, location, grade, character, associations

Question 6

Describe Heart Murmur Grades

Answer 6

Question 7

How does squatting/valsalva affect: MVP, HCM, and AS?

Answer 7

Question 8

What can cause a loud aortic component of S₂? soft? loud pulmonary?

Answer 8

1. Systemic HTN, dilated aortic root
2. Calcific aortic stenosis
3. Pulmonary HTN

Question 9

What is the most common innocent murmur in kids aged 1-14?

Answer 9

Still’s murmur

*systolic murmur with maximum intensity at the left lower sternal border or between the left lower sternal border and apex and has minimal radiation. The murmur has a characteristic vibratory or musical quality, is louder in the supine than sitting position, is louder in hyperdynamic states (fever, anxiety), and usually is grade 1 or grade 2 in intensity. This murmur usually resolves by early adolescence, if not sooner.

Question 10

What do you see in murmurs discovered within first six hours of life? after six hours?

Answer 10

1. valve problem - either regurgitation (tricuspid valve or mitral valve) or stenosis (aortic valve or pulmonary valve)
2. valve pathology or shunt lesions that appear as pulmonary vascular resistance falls (atrial and ventricular septal defects, patent ductus arteriosus, peripheral pulmonary stenosis).

Question 11

What is a cervical venous hum?

Answer 11

• innocent murmur in children
• louder when the patient is sitting with head extended
• softer or absent with rotation or flexion of the head or applying light pressure over the jugular vein when the patient is sitting, or when the patient is supine

Question 12

What is the most common congenital heart lesion?

Answer 12

Bicuspid aortic valve