Cardiac Murmurs

Question 1

Term for murmur that occupies the entire systolic period

Answer 1

Holosystolic or pansystolic

Question 2

When do systolic murmurs begin?

Answer 2

Begin with or after S1

Question 3

When do diastolic murmurs begin?

Answer 3

Begin with or after S2

Question 4

Name the 6 systolic murmurs

Answer 4

Aortic stenosis
Mitral regurgitation
Pulmonic stenosis
Tricuspid regurgitation
mitral valve prolapse
Innocent murmur

Question 5

Second most common cause of valvular heart disease

Answer 5

Aortic Stenosis

Question 6

Most common congenital cardiac abnormality

Answer 6

Aortic Stenosis

Question 7

Causes of aortic stenosis

Answer 7

age-related degenerative calcific changes (most common)
rheumatic valve disease
congenitally deformed valve – bicuspid

Question 8

What is the most common cause of aortic stenosis?

Answer 8

Degenerative AS

Question 9

Pulsus parvus et tardus (narrow pulse pressure) - seen in which pathology

Answer 9

Aortic stenosis

Question 10

Name the cause of this murmur:
Harsh, systolic ejection murmur (ejection type) – ejection click
Location: aortic area
Medium pitch
Crescendo – decrescendo (diamond shaped)
DECREASES with Valsalva
Murmur preceded by ejection click
Heard best at RUSB, Radiates to neck (carotid)
A2 decreases as AS worsens
Paradoxical splitting of S2 – prolonged ejection time
S4
S3 with systolic HF
Weakened and delayed upstroke of carotid artery pulsations
Delayed and diminished
Enlarged PMI
Pulsus parvus et tardus – narrow pulse pressure

Answer 10

Aortic Stenosis

Question 11

Name the cause of this murmur:
Systolic ejection murmur
Heard best at LLSB
Radiates to neck
INCREASES with Valsalva
Associated MR murmur at apex
+S4
Double apical impulse, enlarged PMI
Bisferiens carotid pulse

Answer 11

HCM

Question 12

Name the cause of this murmur:
Apical blowing holosystolic (pansystolic) murmur
Location: apex
Radiates to axilla
Pitch: high
May obliterate S1 and S2
Decreased S1
Presence of S3
S4 if acute
Laterally displaced PMI (chronic)

Answer 12

Mitral Regurgitation

Question 13

Causes of Pulmonic Stenosis

Answer 13

Congenital deformity in 95% of cases
Carcinoid syndome

Question 14

Name the cause of this murmur:
Crescendo-decrescendo systolic murmur at 2nd L ICS
Louder on inspiration
Often associated with a thrill
Preceded by ejection click
Split S2 (widended), soft P2
RV impulse frequently palpable

Answer 14

Pulmonic Stenosis

Question 15

Most common cause of tricuspid valve endocarditis

Answer 15

IV drug use

Question 16

Most common pathogen for tricuspid valve endocarditis from IV drug use

Answer 16

Staph aureus

Question 17

Name the cause of this murmur:
Holosystolic murmur at LLSB
Becomes louder on inspiration (unlike MR)
Prominent v wave in jugular vein
Pulsatile liver

Answer 17

Tricuspid Regurgitation

Question 18

Mitral Valve Prolapse is associated with what connective tissue disorder

Answer 18

Marfan Syndrome

Question 19

What is the pathology of mitral valve prolapse?

Answer 19

Valve leaflets, particularly posterior are enlarged

Normal dense collagen and elastin matrix of valvular fibrosa is fragmented and replaced with loose myxomatous connective tissue

Question 20

What are the three features of “MVP syndrome”?

Answer 20

Characteristic mid-sysolic click
Palpations, fatigue, dyspnea, postural orthostasis, and anxiety
Chest pain

Question 21

Name the cause of this murmur:
Mid-systolic click, late systole
Murmur corresponds to regurgitant flow through the incompetent valve
Late systolic murmur heard best at cardiac apex (if MR present)
Click and murmur can move later in systole with maneuvers which increase LV preload (squatting)

Answer 21

Mitral Valve Prolapse

Question 22

Name the cause of this murmur:
Midsystolic murmur - Head best while supine
Usually decreases or disappears when sitting or upright
Short systolic ejection
Location: 2nd to 4th ICS between left sternal border and apex
Radiation: little
Shape: diamond
Intensity: Grade I-II, possibly III
Medium pitch
Quality: variable, often musical (“vibratory” or “musical”)

Answer 22

Innocent Murmur

Question 23

What is the most common innocent murmur of childhood?

Answer 23

Still’s murmur

Question 24

Name the cause of this murmur:
Present age 2 to adolescence
Heard along left lower and midsternal border
Musical or vibratory
Short early systolic ejection murmur
Grade I-III
Diminished with sitting/standing/Valsalva

Answer 24

Still’s murmur

Question 25

Name the cause of this murmur:
Another very common murmur of childhood
Usually heard after age 3
Turbulence in subclavian and jugular veins
Heard in upper right and left sternal borders and in the neck
Continuous musical hum
More like a bruit than a murmur
Grade I-II
Disappears if child in supine or when jugular vein is compressed

Answer 25

Venous Hum

Question 26

Causes of aortic regurgitation

Answer 26

Abnormalities of valve leaflets
Dilatation of aortic root

Question 27

Name the cause of this murmur:
Soft, high-pitched diastolic decrescendo murmur heard best along 3rd LICS, LSB
Early diastole
Location: aortic area
Radiation: no
Blowing quality
Patient siting, leaning forward after exhaling
Other murmurs
May have systolic ejection murmur at aortic area due to high flow state
Low-frequency mid-diastolic rumbling at apex – Austin Flint murmur
Reflects turbulence across MV during diastole
Bounding pulses
Hyperdynamic LV impulse
PMI displaced caudally and laterally
S3 – when ventricular failure occurs
S4 – ventricular hypertrophy
Wide pulse pressure

Answer 27

Aortic Regurgitation

Question 28

Bisferiens pulse

Answer 28

Double systolic impulse in carotid or brachial artery
Seen in aortic regurgitation

Question 29

Corrigan pulse

Answer 29

“Water-hammer” pulses with marked distention and collapse
Seen in aortic regurgitation

Question 30

de Musset sign

Answer 30

Head-bobbing with each systole

Question 31

Duroziez sign

Answer 31

To-and-fro murmur heard over femoral artery with light compression
Seen in aortic regurgitation

Question 32

Hill sign

Answer 32

Popliteal systolic pressure more than 60mmHg greater than brachial systolic pressure
Seen in aortic regurgitation

Question 33

Muller sign

Answer 33

Systolic pulsations of the uvula
Seen in aortic regurgitation

Question 34

Quincke sign

Answer 34

Capillary pulsations visible at lip or proximal nail bed

Question 35

Traube sign

Answer 35

“Pistol-shot” sound auscultated over femoral artery
Seen in aortic regurgitation

Question 36

Name the cause of this murmur:
Low-frequency mid-diastolic rumbling at apex
Reflects turbulence across MV during diastole

Answer 36

Austin Flint murmur

Question 37

What is the most common cause/pathology for mitral stenosis?

Answer 37

rheumatic fever

Question 38

Name the cause of this murmur:
Right ventricular “tap”
Loud/increased S1
Opening snap
Low frequency decrescendo murmur (diastolic rumble)
Mid to late diastole
Heard best in left lateral decubitus position
Location: apex
No radiation
Quality: rumbling
RV rock
Pre-systolic accentuation

Answer 38

Mitral Stenosis

Question 39

Murmur of pulmonic regurgitation often called what?

Answer 39

Graham-Steell murmur

Question 40

Name the cause of this murmur:
High-pitched diastolic decrescendo murmur, ULSB
Made louder on inspiration
Split S2 (widened)
Loud P2

Answer 40

Pulmonic Regurgitation

Question 41

What valvular pathology almost exclusively accompanies Mitral stenosis?

Answer 41

Tricuspid Stenosis

Question 42

Name the cause of this murmur:
Opening snap
Slightly higher pitched than MS (low to medium pitched)
Murmur heard closer to sternum – LSB
Intensifies on inspiration

Neck veins distended 🡪 giant A wave
Abdominal distension and hepatomegaly
A presystolic hepatic pulsation may be felt
Afib frequently present

Answer 42

Tricuspid Stenosis