Adult Heart Murmurs

Question 1

What are the 4 things you need to record with a heart murmur?

Answer 1

grade
systolic vs diastolic
where heard best?
does it radiate? - carotids or axilla?

Question 2

What murmur is heard with aortic stenosis?

Answer 2

early to mid-systolic (crescendo and descrescendo)

Question 3

Where is an aortic stenosis heard best?

Answer 3

at the base in the aortic area (right lateral stenal border)

Question 4

Where does n aortic stenosis murmur radiate?

Answer 4

carotids

Question 5

What happens to systolic pressure and carotid upstroke in late stages of aortic stenosis?

Answer 5

decreased systolic pressure and slow carotid upstroke

Question 6

What are three etiologies of aortic stenosis?

Answer 6

degenerative calcificication
rheumatic
bicuspid valve

Question 7

What pressure gradient represents a critical obstruction with aortic stenosis.

Answer 7

over 50 mm

Question 8

WHat are some of the symtoms with aortic stenosis?

Answer 8

angina (you can’t perfuse the coronary arteries well)
syncope
dyspnea on exertion

Question 9

WHat’s the treatment for aortic stenosis?

Answer 9

valve replacement or balloon valvuloplasty in children and young adults

Question 10

What sort of murmur is found in mitral insufficiency (regurg)?

Answer 10

holosystolic

Question 11

Where is the mitral insufficiency murmur heard loudest? Radiating to where?

Answer 11

apex and radiating to axilla

Question 12

What are the common etiologies for mitral insufficiency?

Answer 12

rheumatic heart disease
congenital
acute MI with papillary muscle dysfunction
endocarditis
calcificaiton with age

Question 13

What ar ethe symptoms of an ACUTE mitral insufficiency?

Answer 13

pulmonary edema and acute shortness of breath

Question 14

What are the symptoms of a chronic mitral insuficiancy?

Answer 14

severe fatigue and atrial fibrillation (enlarged left atrium is irritable)

Question 15

What are the treatments of mitral insufficiency?

Answer 15

treat any CHF
treat the a fib
surgery for severe cases

Question 16

What murmur is heard in mitral stenosis?

Answer 16

diastolic murmur - low pitched rumble

Question 17

What will often precede the murmur in mitral stenosis?

Answer 17

an opening snap - sort of sounds like an S3, but it’s actually the stenotic valve snapping open

Question 18

Where is a mitral stenosis heard best?

Answer 18

apex with patient in left lateral recumbent position

Question 19

What are the common etiologies of mitral stenosis?

Answer 19

rheumatic and rarely congenital

Question 20

What are the symptoms of mitral stenosis?

Answer 20

dyspnea with exertion and cough, hemoptysis and arterial embolism

Question 21

What are the treatments for mitral stenosis?

Answer 21

antibiotic prophylaxis (to avoid endo)
CHF treatment
treat a fib
valve replacment

Question 22

When do you replace a stenotic mitral valve?

Answer 22

when the valve area is less than 1.0 cm2

Question 23

What murmur do you hear with aortic insufficieny?

Answer 23

high pitched diastolic murmur

Question 24

Where is an aortic insufficiency murmur heard best?

Answer 24

at the base

best heard with patient sitting

Question 25

What sort of pulse will occur with aortic insufficiency?

Answer 25

"water hammer" bounding pulse because the pulse pressure is increased due to decreased diastolic pressure

Question 26

What are the etiologies of aortic insufficiency?

Answer 26

2/3 are rheymatic endocarditis trauma congential

Question 27

What happens to stroke volume with aortic insufficy?

Answer 27

increases - blood regugitates back into left ventricle

Question 28

What symptoms will occur with aortic insufficiency?

Answer 28

asymptomatic for years uncomfortable awareness of heartbeat with lying down exertional dyspnea first symptom followed by orthopnea and pND angina CHF

Question 29

What sort of murmur will your heart with a mtiral valve prolapse?

Answer 29

mid or late systolic click followed by a high pitched late systolic murmur

Question 30

Where is mitral valve prolapse heard best?

Answer 30

at apex

Question 31

What group most commonly has mitral valve prolapse?

Answer 31

very common - females between 14 and 30

Question 32

What is the pathophysiology of mitral valve prolapse?

Answer 32

myxomatous degeneration of the posterior leaflet

Question 33

Mitral valve prolapse is usually benign but can cause what?

Answer 33

can trigger arrhythmias

Question 34

What murmur will you hear with tricuspid stenosis? Heard where?

Answer 34

diastolic murmur heard best along lower left sternal border and xiphoid

Question 35

What will happen to jugular venous pulsations in tricuspid stenosis?

Answer 35

giant A wave in neck

Question 36

Tricuspid regurgitation is functional from what?

Answer 36

dilation of the right ventricle - a sign of right sided heart failure

Question 37

What murmur do you hear in tricuspid regurgitaiton? Where?

Answer 37

holosystolic murmur at the tricuspid area

Question 38

WHat happens to venous jugular pulsations in tricuspid regurg?

Answer 38

prominent V wave

Question 39

Pulmonic stenosis murmur is usually preceded by what?

Answer 39

an ejection click

Question 40

What murmur do you see with pulmonic stenosis?

Answer 40

midsystolic murmur at left 2nd and 3rd interspaces

Question 41

If you hear a pulmonic stenosis murmur in a young person, should you be concerne?

Answer 41

probably benign

Question 42

Describe an innocent murmur.

Answer 42

1. always systolic in nature 2. occur without evidence of physiologic abnormalities 3. grade 1 or 2 4. no thrills or radiation 5. end well before S2 found in 30-50% of children!