Car 9 - Systolic Heart Murmur

Question 1

What are the five systolic heart murmurs?

Answer 1

Aortic stenosis. Mitral regurgitation. Mitral valve prolapse. Tricuspid prolapse. VSD.

Question 2

What are the clinical clues in Aortic Stenosis?

Answer 2

Ejection click (EC): Click after a slight pause after S1; the murmur that follows the click has been described as crescendo, decrescendo. Best heard at aortic position (right second intercostal space). Murmur radiates to carotids. Weak, delayed peripheral pulses. Might have syncope. Angina and dyspnea can present.

Question 3

What are the five causes of aortic stenosis?

Answer 3

Bicuspid aortic valve (doesn’t cause problems till age 40). Senile (degenerative) calcification (around age 60). Rheumatic valve disease. Unicuspid aortic valve. Syphilis.

Question 4

What are clinical clues for Mitral regurgitation (MR)?

Answer 4

Murmur immediately after S1 to S2, no murmur after S2 (holosystolic murmur). Also called high-pitched, blowing murmur. Best heard at mitral area (left 5th intercostal space); can radiate to left axilla. Best heard in left lateral decubitus position. Enhanced by maneuvers that ^ afterload: handgrip and squatting.

Question 5

What are the five causes of Mitral regurgitation?

Answer 5

Rheumatic heart disease. Endocarditis. Ischemic heart disease. Left ventricular dilation. Mitral valve prolapse.

Question 6

What are the clinical clues of Mitral valve prolapse?

Answer 6

Midsystolic click (MC): b/w S1 and S2, and a systolic crescendo murmur after the click that increases in intensity till S2. Valsalva makes the click and murmur earlier, but murmur softer.

Question 7

What are the clinical clues of Tricuspid regurgitation?

Answer 7

Holosystolic sound From S1 to S2. Loudest on the tricuspid area. Murmur gets louder w/ inspiration.

Question 8

What are the causes of tricuspid regurgitation?

Answer 8

Rheumatic fever. Endocarditis (IV drug users).

Question 9

What would be the clinical clues of Ventricular septal defect?

Answer 9

Holosystolic murmur from S1 to S2. Heard best at tricuspid area. Gets louder w/ inspiration; all just like tricuspid regurgitation.

Question 10

Which heart murmur is associated w/ weak pulses?

Answer 10

Aortic stenosis.

Question 11

Which pathology is associated w/ the following murmur: Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd right interspace close to the sternum.

Answer 11

Aortic stenosis.

Question 12

Which pathology is associated w/ each of the following murmurs: Early diastolic decrescendo murmur heard best along the upper left side of the sternum?

Answer 12

Pulmonic regurgitation.

Question 13

Which pathology is associated w/ each of the following murmurs: late diastolic decrescendo murmur heard best along the lower left side of the sternum.

Answer 13

Tricuspid stenosis.

Question 14

Which pathology is associated w/ each of the following murmurs: Pansystolic (AKA holosystolic) murmur best heard at the apex and often radiates to the left axilla.

Answer 14

Mitral valve regurgitation.

Question 15

Which pathology is associated w/ each of the following murmurs: Late systolic murmur usually preceded by a mid-systolic click.

Answer 15

Mitral valve prolapse.

Question 16

Which pathology is associated w/ each of the following murmurs: crescendo-decrescendo systolic murmur best heard in the 2nd-3rd left interspaces close to the sternum.

Answer 16

Pulmonic stenosis.

Question 17

Which pathology is associated w/ each of the following murmurs: pansystolic (AKA holosystolic or uniform) murmur best heard along the left lower sternal border and generally radiates to the right lower sternal border.

Answer 17

VSD or Tricuspid regurgitation.

Question 18

Which pathology is associated w/ each of the following murmurs: Rumbling late diastolic murmur w/ an opening snap, heard loudest in the 5th interspace in the midaxillary line.

Answer 18

Mitral stenosis.

Question 19

Which pathology is associated w/ each of the following murmurs: continuous machine-like murmur (in systole and diastole).

Answer 19

Patent ductur arteriosus. PDA.

Question 20

Which pathology is associated w/ each of the following murmurs: high-pitched diastolic murmur associated w/ a widened pulse pressure.

Answer 20

Aortic regurgitation.

Question 21

What is the name of the pulses caused by aortic stenosis?

Answer 21

Pulsus Parvus et Tardus (weak and delayed pulses).